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NPI Code Detail

MEDICARE: MS. LISA EMILIA RIVERA

MEDICARE: MS. LISA EMILIA RIVERA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2106S00000XBehavior Technician1265794259

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265794259
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA EMILIA RIVERA
Provider Business Mailing Address
First Line : 5617 NW 106TH WAY
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33076-3106
Country : US
Telephone Number : 646-717-2797
Fax Number :
Provider Business Practice Location Address
First Line : 3520 OAKS WAY APT 904
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33069-5387
Country : US
Telephone Number : 305-807-1909
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2012
Last Update Date : 06/10/2022

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Directions to “ MS. LISA EMILIA RIVERA ” Practice Location

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