Healthcare Provider Details

I. General information

NPI: 1356010367
Provider Name (Legal Business Name): YONIELIS RIVERO NOBREGA BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 SW PALM DR APT 108
PORT ST LUCIE FL
34986-1796
US

IV. Provider business mailing address

161 SW PALM DR APT 108
PORT SAINT LUCIE FL
34986-1796
US

V. Phone/Fax

Practice location:
  • Phone: 786-930-9723
  • Fax:
Mailing address:
  • Phone: 786-930-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-122342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: