MEDICARE: MS. MAYTE RIVERA LDO

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	156FX1800X	Optician	DO7539	FL
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1548074503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAYTE RIVERA LDO

Provider Business Mailing Address
First Line	:	11442 NW 93RD CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4268
Country	:	US
Telephone Number	:	305-799-9275
Fax Number	:

Provider Business Practice Location Address
First Line	:	11442 NW 93RD CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4268
Country	:	US
Telephone Number	:	305-799-9275
Fax Number	:

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

Provider Enumeration Date	:	02/01/2025
Last Update Date	:	02/28/2026

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