Healthcare Provider Details

I. General information

NPI: 1992380323
Provider Name (Legal Business Name): EDUARDO RIVERO MOYA RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 ANITA AVE N
LEHIGH ACRES FL
33971-7715
US

IV. Provider business mailing address

2921 ANITA AVE N
LEHIGH ACRES FL
33971-7715
US

V. Phone/Fax

Practice location:
  • Phone: 786-306-6321
  • Fax:
Mailing address:
  • Phone: 786-306-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-124574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: