Provider Demographics
NPI:1366127052
Name:RIVERO ROMAN, ABRAHAM
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:RIVERO ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 SW 52ND CT APT 2W
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-6521
Mailing Address - Country:US
Mailing Address - Phone:754-246-5930
Mailing Address - Fax:
Practice Address - Street 1:4401 SW 52ND CT APT 2W
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33314-6521
Practice Address - Country:US
Practice Address - Phone:754-246-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician