Provider Demographics
NPI:1114662871
Name:YULFO MATIAS, KARIANA MARIE
Entity Type:Individual
Prefix:
First Name:KARIANA
Middle Name:MARIE
Last Name:YULFO MATIAS
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 1:5030 CHAMPION BLVD STE G11-535
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2473
Mailing Address - Country:US
Mailing Address - Phone:561-235-7683
Mailing Address - Fax:
Practice Address - Street 1:2900 N MILITARY TRL STE 241
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6347
Practice Address - Country:US
Practice Address - Phone:561-678-0661
Practice Address - Fax:561-464-5501
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR143801041C0700X
FLTPSW19121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical