Provider Demographics
NPI:1194026955
Name:RIVERO FUNDORA, ALBERTO (MT)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:RIVERO FUNDORA
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 SW 7TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3563
Mailing Address - Country:US
Mailing Address - Phone:305-370-5374
Mailing Address - Fax:305-460-0075
Practice Address - Street 1:8300 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-6000
Practice Address - Country:US
Practice Address - Phone:305-460-0045
Practice Address - Fax:305-460-0075
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60725225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist