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General NPI Number Information
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NPI Number | 1124806781
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Entity Type | Individual
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Provider Name | ANGEL GABRIEL RIVERA
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Gender | Male
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 2901 E IRLO BRONSON MEMORIAL HWY STE D
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City | KISSIMMEE
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State | FL
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Zip | 34744-5600
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Country | US
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Telephone | 407-483-4750
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 STATION SQ APT 417
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City | KISSIMMEE
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State | FL
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Zip | 34744-1643
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Country | US
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Telephone | 689-241-1028
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-315279
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License Number State | FL
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