Provider Demographics
NPI:1740015304
Name:RIVERA, ELIZABETH MONIQUE (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MONIQUE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 EGRET DR APT 123
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5792
Mailing Address - Country:US
Mailing Address - Phone:224-392-2132
Mailing Address - Fax:847-241-0036
Practice Address - Street 1:3580 MYSTIC POINTE DR
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2554
Practice Address - Country:US
Practice Address - Phone:224-392-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA105130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist