Provider Demographics
NPI:1013689751
Name:RIVERO, YERANDY
Entity Type:Individual
Prefix:
First Name:YERANDY
Middle Name:
Last Name:RIVERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 NW 93RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-3145
Mailing Address - Country:US
Mailing Address - Phone:786-285-8466
Mailing Address - Fax:
Practice Address - Street 1:1901 NW 93RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-3145
Practice Address - Country:US
Practice Address - Phone:786-364-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician