Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003324633 |
---|---|
Provider Name | Luis Rivera |
First Address | Lake Mary, FL 32746-5028 |
Second Address | Brandon, FL 33511-4850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2018 |
Last Update Date | 24/06/2020 |