Provider Demographics
NPI:1598507956
Name:TEJEDA RIVERO, YAMILET
Entity type:Individual
Prefix:
First Name:YAMILET
Middle Name:
Last Name:TEJEDA 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 1:2870 OCONNELL DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7755
Mailing Address - Country:US
Mailing Address - Phone:702-582-2719
Mailing Address - Fax:
Practice Address - Street 1:2870 OCONNELL DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7755
Practice Address - Country:US
Practice Address - Phone:702-582-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-344508106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician