Provider Demographics
NPI:1720747975
Name:RIVERA CARDONA, MARIA TERESA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:RIVERA CARDONA
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 1:930 SW 135TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1883
Mailing Address - Country:US
Mailing Address - Phone:305-992-2584
Mailing Address - Fax:
Practice Address - Street 1:930 SW 135TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1883
Practice Address - Country:US
Practice Address - Phone:305-992-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-140729106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician