MEDICARE: DR. VILMA GARRIDO RIQUENES

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	23754	FL
2	106S00000X	Behavior Technician	00000000000000000000	CA

General Provider Information

NPI Number	:	1205398310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VILMA GARRIDO RIQUENES

Provider Business Mailing Address
First Line	:	12863 SW 42ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3434
Country	:	US
Telephone Number	:	786-234-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 E PACIFIC COAST HWY APT P233
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3295
Country	:	US
Telephone Number	:	786-234-1609
Fax Number	:

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

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	05/29/2024

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