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NPI Code Detail

MEDICARE: JAM LUIS RIVERA

MEDICARE: JAM LUIS RIVERA
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
1106S00000XBehavior TechnicianRBT-26-516431FL

General Provider Information

NPI Number : 1285576215
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAM LUIS RIVERA
Provider Business Mailing Address
First Line : 1219 SE 34TH ST
Second Line :
City : CAPE CORAL
State : FL
Zip : 33904-4291
Country : US
Telephone Number : 239-703-3502
Fax Number : 239-703-3502
Provider Business Practice Location Address
First Line : 1219 SE 34TH ST
Second Line :
City : CAPE CORAL
State : FL
Zip : 33904-4291
Country : US
Telephone Number : 239-703-3502
Fax Number : 239-703-3502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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Directions to “ JAM LUIS RIVERA ” Practice Location

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