MEDICARE: MISS LISY RIVERO GONZALEZ BCABA

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	106E00000X	Assistant Behavior Analyst	0-25-15784	FL
2	106S00000X	Behavior Technician	RBT-20-116037	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396361838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LISY RIVERO GONZALEZ BCABA

Provider Business Mailing Address
First Line	:	814 SW 147TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33027-6126
Country	:	US
Telephone Number	:	786-372-5051
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 SW 147TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33027-6126
Country	:	US
Telephone Number	:	786-372-5051
Fax Number	:

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

Provider Enumeration Date	:	06/21/2020
Last Update Date	:	03/25/2026

Similar Medicare Providers

1861954026 — IKDO STAR LLC
Practice Location Address:

12190 W EVELY PINES LN
STAR, ID
83669-6126

Practice Phone: 208-884-4466
Practice Fax:

1194463778 — JAKOB RODGERS DDS
Practice Location Address:

12190 W EVELY PINES LN
STAR, ID
83669-6126

Practice Phone: 208-996-3003
Practice Fax:

1578285532 — BRITTANY CHRISTIANNA SKINNER APRN
Practice Location Address:

880 SW 145TH AVE STE 202
PEMBROKE PINES, FL
33027-6171

Practice Phone: 866-849-0692
Practice Fax:

1710825492 — DR. YANILIS DIAZ MD, PA
Practice Location Address:

13300 SW 1ST ST APT O201
PEMBROKE PINES, FL
33027-1611

Practice Phone: 786-634-8945
Practice Fax:

1700339249 — KRISTIE A SMITH NP
Practice Location Address:

880 SW 145TH AVE STE 202
PEMBROKE PINES, FL
33027-6171

Practice Phone: 866-849-0692
Practice Fax:

1033566377 — MS. SAMANTHA CARLA LEON ARNP
Practice Location Address:

880 SW 145TH AVE STE 202
PEMBROKE PINES, FL
33027-6171

Practice Phone: 866-849-0692
Practice Fax:

Directions to “ MISS LISY RIVERO GONZALEZ BCABA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.