Provider Demographics
NPI:1316499494
Name:RIVERO AYALA, MAIVIS
Entity type:Individual
Prefix:
First Name:MAIVIS
Middle Name:
Last Name:RIVERO AYALA
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 1:876 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-4223
Mailing Address - Country:US
Mailing Address - Phone:305-934-3423
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:876 E 22ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-4223
Practice Address - Country:US
Practice Address - Phone:305-934-3423
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician