Provider Demographics
NPI:1578373197
Name:RIVERA, KARLO ANDRES
Entity type:Individual
Prefix:
First Name:KARLO
Middle Name:ANDRES
Last Name:RIVERA
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 1:1604 PINE MARSH LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-7408
Mailing Address - Country:US
Mailing Address - Phone:787-595-2032
Mailing Address - Fax:
Practice Address - Street 1:711 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4573
Practice Address - Country:US
Practice Address - Phone:407-846-0533
Practice Address - Fax:407-518-1730
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9477172163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse