Provider Demographics
NPI:1275405755
Name:RIVERO DIAZ, MARILYN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:RIVERO DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 SE 24TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1964
Mailing Address - Country:US
Mailing Address - Phone:239-422-6031
Mailing Address - Fax:
Practice Address - Street 1:1028 SE 24TH AVE UNIT B
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1964
Practice Address - Country:US
Practice Address - Phone:239-422-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-398222106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty