Provider Demographics
NPI:1154981728
Name:RIVERA QUINTERO, ESTEPFANIA
Entity type:Individual
Prefix:
First Name:ESTEPFANIA
Middle Name:
Last Name:RIVERA QUINTERO
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 1:810 SW 129TH PL APT 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2169
Mailing Address - Country:US
Mailing Address - Phone:305-772-4632
Mailing Address - Fax:
Practice Address - Street 1:810 SW 129TH PL APT 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2169
Practice Address - Country:US
Practice Address - Phone:305-772-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-62418106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty