Provider Demographics
NPI:1053025031
Name:RIVERO GARCIA, YANOVIS
Entity type:Individual
Prefix:
First Name:YANOVIS
Middle Name:
Last Name:RIVERO GARCIA
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 1:1401 LIBERTY ST APT 8
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2262
Mailing Address - Country:US
Mailing Address - Phone:954-882-2923
Mailing Address - Fax:
Practice Address - Street 1:1401 LIBERTY ST APT 8
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2262
Practice Address - Country:US
Practice Address - Phone:954-882-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-244505106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician