Provider Demographics
NPI:1083181762
Name:CHAVEZ GOMEZ, YARIVEY
Entity Type:Individual
Prefix:
First Name:YARIVEY
Middle Name:
Last Name:CHAVEZ GOMEZ
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 1:7575 W FLAGLER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2467
Mailing Address - Country:US
Mailing Address - Phone:307-377-3297
Mailing Address - Fax:305-377-3854
Practice Address - Street 1:7575 W FLAGLER ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2467
Practice Address - Country:US
Practice Address - Phone:307-377-3297
Practice Address - Fax:305-377-3854
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-69031106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102963500Medicaid