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General NPI Number Information
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NPI Number | 1265794259
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Entity Type | Individual
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Provider Name | MS. LISA EMILIA RIVERA
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Gender | Female
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 3520 OAKS WAY APT 904
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City | POMPANO BEACH
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State | FL
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Zip | 33069-5387
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Country | US
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Telephone | 305-807-1909
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Fax |
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Provider Business Mailing Address
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Address Line | 5617 NW 106TH WAY
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3106
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Country | US
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Telephone | 646-717-2797
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1265794259
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License Number State |
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