Provider Demographics
NPI:1184197402
Name:CANIZARES RIVERO, YADIRA B
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:B
Last Name:CANIZARES RIVERO
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 1:10300 SW 72ND ST STE 275C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3032
Mailing Address - Country:US
Mailing Address - Phone:786-445-5607
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 72ND ST STE 275C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3032
Practice Address - Country:US
Practice Address - Phone:786-445-5607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-123007106S00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No253Z00000XAgenciesIn Home Supportive Care