MEDICARE: WIND RIVER MEDICAL GROUP INC.

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	101YM0800X	Mental Health Counselor		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	:	1861970865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIND RIVER MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	900 W 49TH ST STE 300
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3407
Country	:	US
Telephone Number	:	305-726-8997
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W 49TH ST STE 300
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3407
Country	:	US
Telephone Number	:	305-726-8997
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YOEL NAVEIRA
Credential	:
Telephone Number	:	305-726-8997

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	06/05/2020

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