Provider Demographics
NPI:1336924505
Name:RIVERA DOPICO, MELIZA
Entity Type:Individual
Prefix:
First Name:MELIZA
Middle Name:
Last Name:RIVERA DOPICO
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 1:3111 53RD ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-0763
Mailing Address - Country:US
Mailing Address - Phone:702-350-8941
Mailing Address - Fax:
Practice Address - Street 1:3111 53RD ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-0763
Practice Address - Country:US
Practice Address - Phone:702-350-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician