Provider Demographics
NPI:1427826676
Name:RIVERO REY, LIOBER Y
Entity type:Individual
Prefix:
First Name:LIOBER
Middle Name:Y
Last Name:RIVERO REY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16420 SW 292ND ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2108
Mailing Address - Country:US
Mailing Address - Phone:786-491-4659
Mailing Address - Fax:
Practice Address - Street 1:16420 SW 292ND ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2108
Practice Address - Country:US
Practice Address - Phone:786-491-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-141320106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician