Healthcare Provider Details

I. General information

NPI: 1740944453
Provider Name (Legal Business Name): MANUEL RIVERO JR. APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 SW 87TH CT STE 112
MIAMI FL
33176-2264
US

IV. Provider business mailing address

8765 NW 110TH ST
HIALEAH GARDENS FL
33018-4510
US

V. Phone/Fax

Practice location:
  • Phone: 786-840-3454
  • Fax:
Mailing address:
  • Phone: 786-389-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11019732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: