MEDICARE: MR. CARLOS ABRAHAN RIVERON LOPEZ SR.

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

General Provider Information

NPI Number	:	1588473813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS ABRAHAN RIVERON LOPEZ SR.

Provider Business Mailing Address
First Line	:	8741 SW 137TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4077
Country	:	US
Telephone Number	:	786-799-1698
Fax Number	:

Provider Business Practice Location Address
First Line	:	18950 SW 106TH AVE STE 118
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33157-7699
Country	:	US
Telephone Number	:	305-614-1230
Fax Number	:	305-503-9624

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

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

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