Provider Demographics
NPI:1528572419
Name:ESTEVEZ RIVERO, YANET
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:ESTEVEZ 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 1:1475 W 39TH PL APT 204
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4769
Mailing Address - Country:US
Mailing Address - Phone:786-557-7582
Mailing Address - Fax:
Practice Address - Street 1:1475 W 39TH PL APT 204
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4769
Practice Address - Country:US
Practice Address - Phone:786-557-7582
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-19-10273106E00000X, 106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104344400Medicaid