Provider Demographics
NPI:1740944453
Name:RIVERO, MANUEL JR (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:RIVERO
Suffix:JR
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 NW 110TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4510
Mailing Address - Country:US
Mailing Address - Phone:786-389-2691
Mailing Address - Fax:
Practice Address - Street 1:8955 SW 87TH CT STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2264
Practice Address - Country:US
Practice Address - Phone:786-840-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019732363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health