MEDICARE: ALIAN HERNANDEZ RIVERO

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
1	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1780263244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIAN HERNANDEZ RIVERO

Provider Business Mailing Address
First Line	:	11351 SW 41ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4606
Country	:	US
Telephone Number	:	786-296-7676
Fax Number	:

Provider Business Practice Location Address
First Line	:	11351 SW 41ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4606
Country	:	US
Telephone Number	:	786-296-7676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	09/15/2021

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