Healthcare Provider Details

I. General information

NPI: 1225947344
Provider Name (Legal Business Name): IDANIEL RIVERO RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 LAKE WORTH RD STE 201-Q
GREENACRES FL
33463-3204
US

IV. Provider business mailing address

14740 SW 284TH ST
HOMESTEAD FL
33033-1528
US

V. Phone/Fax

Practice location:
  • Phone: 561-508-6900
  • Fax:
Mailing address:
  • Phone: 786-370-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: