Individual provider Active NPI

Vilma Garrido Riquenes

  • Behavior Technician
  • Long Beach, CA
National Provider Identifier
1205398310
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
00000000000000000000 Issued in CA
Practice address
5025 E Pacific Coast Hwy Apt P233
Long Beach, CA 90804-3295
Phone
(786) 234-1609
NPI assigned
Apr 5, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 23754 FL
Behavior TechnicianGroup: 193400000X SINGLE SPECIALTY GROUP 106S00000X 00000000000000000000 CA Primary

Addresses

Primary practice location

5025 E Pacific Coast Hwy Apt P233
Long Beach, CA 90804-3295

Mailing address

12863 SW 42ND St
Miami, FL 33175-3434
Phone (786) 234-1609

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
23754FLMDMental Health Counselor
00000000000000000000CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
My Roots of Life CurrentSince Jun 2, 2024 Accepting new patients

Locations

12863 SW 42nd St
Miami, FL 33175
Phone (786) 234-1609

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1205398310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12863 SW 42ND ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331753434",
            "telephone_number": "786-234-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5025 E PACIFIC COAST HWY APT P233",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908043295",
            "telephone_number": "786-234-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIQUENES",
        "first_name": "VILMA",
        "middle_name": "GARRIDO",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-05",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "23754",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "00000000000000000000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.