Provider Demographics
NPI:1356010367
Name:RIVERO NOBREGA, YONIELIS (BS)
Entity Type:Individual
Prefix:
First Name:YONIELIS
Middle Name:
Last Name:RIVERO NOBREGA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 LIVE OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2348
Mailing Address - Country:US
Mailing Address - Phone:786-560-4198
Mailing Address - Fax:
Practice Address - Street 1:2064 LIVE OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2348
Practice Address - Country:US
Practice Address - Phone:786-560-4198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122342106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCM103776Medicaid
FLBACB513894Medicaid
FLRBT-20-122342Medicaid