Healthcare Provider Details

I. General information

NPI: 1679009914
Provider Name (Legal Business Name): ANABEL RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 08/07/2021
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 RUNNING HORSE RD
SEFFNER FL
33584-4139
US

IV. Provider business mailing address

505 RUNNING HORSE RD
SEFFNER FL
33584-4139
US

V. Phone/Fax

Practice location:
  • Phone: 786-768-0327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-19-10345
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-57515
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43095
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: