Healthcare Provider Details

I. General information

NPI: 1740976216
Provider Name (Legal Business Name): MARIAM DE LA CARIDAD RIVERON MONTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 MAITLAND CENTER COMMONS BLVD STE 225
MAITLAND FL
32751-7202
US

IV. Provider business mailing address

602 W AVENIDA DEL RIO
CLEWISTON FL
33440-2321
US

V. Phone/Fax

Practice location:
  • Phone: 386-320-5356
  • Fax:
Mailing address:
  • Phone: 689-205-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-268739
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-25-16236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: