Healthcare Provider Details

I. General information

NPI: 1306345202
Provider Name (Legal Business Name): AILYN RIVERO LEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19718 NW 84TH CT
HIALEAH FL
33015-6961
US

IV. Provider business mailing address

19718 NW 84TH CT
HIALEAH FL
33015-6961
US

V. Phone/Fax

Practice location:
  • Phone: 786-291-4225
  • Fax:
Mailing address:
  • Phone: 786-291-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: