Provider Demographics
NPI:1861970865
Name:WIND RIVER MEDICAL GROUP INC.
Entity type:Organization
Organization Name:WIND RIVER MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-726-8997
Mailing Address - Street 1:900 W 49TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3407
Mailing Address - Country:US
Mailing Address - Phone:305-726-8997
Mailing Address - Fax:
Practice Address - Street 1:900 W 49TH ST STE 300
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3407
Practice Address - Country:US
Practice Address - Phone:305-726-8997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty