Provider Demographics
NPI:1932940665
Name:VIVO JUSTIZ, YAIZA YAMARA
Entity type:Individual
Prefix:
First Name:YAIZA
Middle Name:YAMARA
Last Name:VIVO JUSTIZ
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 1:722 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3640
Mailing Address - Country:US
Mailing Address - Phone:786-817-4129
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST STE 225
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6664
Practice Address - Country:US
Practice Address - Phone:786-652-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-345712103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst