Healthcare Provider Details

I. General information

NPI: 1699419531
Provider Name (Legal Business Name): MARYORIE W RIERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SW 122ND AVE STE 108-110
MIAMI FL
33186-5265
US

IV. Provider business mailing address

7865 NW 104TH AVE APT 33
DORAL FL
33178-4468
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2900
  • Fax: 786-364-1676
Mailing address:
  • Phone: 786-543-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-90961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: