MEDICARE: SUSEL RIERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	12152500	FL

General Provider Information

NPI Number	:	1063869931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSEL RIERA

Provider Business Mailing Address
First Line	:	1900 N BAYSHORE DR # 1A-122
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33132-3001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 NORTH BAY DR. #1A-122
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33012-1456
Country	:	US
Telephone Number	:	305-901-9453
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	11/19/2021

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Directions to “ SUSEL RIERA ” Practice Location

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