MEDICARE: CHANEL 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
1	106S00000X	Behavior Technician	RBT24340372	FL

General Provider Information

NPI Number	:	1316791239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANEL RIVERA

Provider Business Mailing Address
First Line	:	31032 SW 192ND CT
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33030-3723
Country	:	US
Telephone Number	:	786-478-9443
Fax Number	:

Provider Business Practice Location Address
First Line	:	9143 SW 170TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-2944
Country	:	US
Telephone Number	:	786-442-5867
Fax Number	:

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

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	07/11/2025

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Directions to “ CHANEL RIVERA ” Practice Location

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