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General NPI Number Information
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NPI Number | 1447083555
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Entity Type | Individual
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Provider Name | ANGELIS RIVERA
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Gender | Female
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Dates
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Enumeration Date | 08/23/2024
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Last Update Date | 08/25/2024
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Provider Practice Location Address
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Address Line | 730 W SAND LAKE RD SUITE 128
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City | ORLANDO
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State | FL
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Zip | 32809
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Country | US
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Telephone | 407-214-5539
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Fax |
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Provider Business Mailing Address
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Address Line | 9933 EARLSTON ST
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City | ORLANDO
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State | FL
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Zip | 32817-1829
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Country | US
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Telephone | 407-388-4394
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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 | BACB1167736
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License Number State | FL
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