Healthcare Provider Details

I. General information

NPI: 1043129158
Provider Name (Legal Business Name): SOFIA ISABEL RIVERO MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

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

4941 WHISTLING WIND AVE
KISSIMMEE FL
34758-3286
US

IV. Provider business mailing address

4941 WHISTLING WIND AVE
KISSIMMEE FL
34758-3286
US

V. Phone/Fax

Practice location:
  • Phone: 407-837-0523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2846370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: