Provider Demographics
NPI:1114765682
Name:CHAVEZ DEL RIO, YADRIEL
Entity type:Individual
Prefix:
First Name:YADRIEL
Middle Name:
Last Name:CHAVEZ DEL RIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 TAMIAMI TRL N STE 128
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4135
Mailing Address - Country:US
Mailing Address - Phone:800-961-3367
Mailing Address - Fax:
Practice Address - Street 1:3201 TAMIAMI TRL N STE 128
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4135
Practice Address - Country:US
Practice Address - Phone:800-961-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24319828106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician