Provider Demographics
NPI:1912493321
Name:RIVERO MARRERO, KAILEN (ARNP9453864)
Entity Type:Individual
Prefix:MS
First Name:KAILEN
Middle Name:
Last Name:RIVERO MARRERO
Suffix:
Gender:F
Credentials:ARNP9453864
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:786-347-5022
Practice Address - Street 1:1490 NW 27TH AVE STE 130
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2173
Practice Address - Country:US
Practice Address - Phone:305-635-7710
Practice Address - Fax:786-621-7817
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9453864363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9453864OtherAPRN LICENSE
FL105263500Medicaid