Provider Demographics
NPI:1407530611
Name:RIVERA SARMIENTO, TATIANA PAOLA
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:PAOLA
Last Name:RIVERA SARMIENTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 NW 114TH PL APT 254
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4510
Mailing Address - Country:US
Mailing Address - Phone:786-638-9384
Mailing Address - Fax:
Practice Address - Street 1:6201 NW 114TH PL APT 254
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4510
Practice Address - Country:US
Practice Address - Phone:786-638-9384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
FLRBT-25-439030106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker