Provider Demographics
NPI:1881418671
Name:JAS RIVADENEIRA, EDUARDO RAFAEL
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:RAFAEL
Last Name:JAS RIVADENEIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5981 CURRY FORD RD APT 323
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4261
Mailing Address - Country:US
Mailing Address - Phone:321-276-6492
Mailing Address - Fax:
Practice Address - Street 1:5981 CURRY FORD RD APT 323
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-4261
Practice Address - Country:US
Practice Address - Phone:321-276-6492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-391384106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician