Provider Demographics
NPI:1215788179
Name:RIVERA, DIANE DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:DE LA CARIDAD
Last Name:RIVERA
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 1:17961 SW 143RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7664
Mailing Address - Country:US
Mailing Address - Phone:786-623-7228
Mailing Address - Fax:
Practice Address - Street 1:2020 PONCE DE LEON BLVD STE 1201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4476
Practice Address - Country:US
Practice Address - Phone:305-917-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician