Provider Demographics
NPI:1639791973
Name:RIVERA DIAZ, YANELKIS (RBT)
Entity Type:Individual
Prefix:
First Name:YANELKIS
Middle Name:
Last Name:RIVERA DIAZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 SW 129TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5839
Mailing Address - Country:US
Mailing Address - Phone:786-239-9901
Mailing Address - Fax:
Practice Address - Street 1:10024 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3603
Practice Address - Country:US
Practice Address - Phone:305-586-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician