Healthcare Provider Details

I. General information

NPI: 1902399801
Provider Name (Legal Business Name): DANIEL ANDRES RIVAS BT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD STE 400
HOLLYWOOD FL
33021-6918
US

IV. Provider business mailing address

13810 SW 112TH ST APT 103
MIAMI FL
33186-3211
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax:
Mailing address:
  • Phone: 716-969-3653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: