Provider Demographics
NPI:1043018294
Name:ORTEGA RIVAS, YAIREMIS
Entity type:Individual
Prefix:
First Name:YAIREMIS
Middle Name:
Last Name:ORTEGA RIVAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20205 SW 122ND AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5284
Mailing Address - Country:US
Mailing Address - Phone:786-856-8436
Mailing Address - Fax:
Practice Address - Street 1:20205 SW 122ND AVE APT 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-5284
Practice Address - Country:US
Practice Address - Phone:786-856-8436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician