Individual
MIA ARIEL RIVARDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
255 EXECUTIVE DR STE LL105, PLAINVIEW, NY 11803-1718
(516) 576-0962
Mailing address
511 DECATUR ST APT 2, BROOKLYN, NY 11233-1502
(504) 432-4069
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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