Provider Demographics
NPI:1124642566
Name:GARCIA RIVERON, YUSMARY
Entity type:Individual
Prefix:
First Name:YUSMARY
Middle Name:
Last Name:GARCIA RIVERON
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 1:250 W 74TH PL APT 305
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5043
Mailing Address - Country:US
Mailing Address - Phone:786-389-7852
Mailing Address - Fax:
Practice Address - Street 1:12030 SW 129TH CT STE 211
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4584
Practice Address - Country:US
Practice Address - Phone:305-639-8760
Practice Address - Fax:786-953-5144
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FLCBHM.0105465-P171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician