Healthcare Provider Details

I. General information

NPI: 1801649116
Provider Name (Legal Business Name): YUSNAVY ROQUE VIERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 SE 21ST AVE
CAPE CORAL FL
33990-2785
US

IV. Provider business mailing address

814 SE 21ST AVE
CAPE CORAL FL
33990-2785
US

V. Phone/Fax

Practice location:
  • Phone: 786-779-9084
  • Fax:
Mailing address:
  • Phone: 786-779-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: