MEDICARE: YAMILE NAYIBE REVEIZ M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME140029	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841684719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMILE NAYIBE REVEIZ M.D

Provider Business Mailing Address
First Line	:	7182 WILTON DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-1982
Country	:	US
Telephone Number	:	210-606-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	25097 OLYMPIA AVE STE 205
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3912
Country	:	US
Telephone Number	:	941-347-8341
Fax Number	:	941-347-7702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	08/14/2020

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