Provider Demographics
NPI:1588495741
Name:RIVERA, DIEGO
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:RIVERA
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 1:220 SE 2ND ST APT 2418
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-4287
Mailing Address - Country:US
Mailing Address - Phone:786-720-4907
Mailing Address - Fax:
Practice Address - Street 1:220 SE 2ND ST APT 2418
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-4287
Practice Address - Country:US
Practice Address - Phone:786-720-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician