MEDICARE: YAQUELIN BLANCO GUERRA

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	106S00000X	Behavior Technician	24-339678	FL

General Provider Information

NPI Number	:	1205689163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAQUELIN BLANCO GUERRA

Provider Business Mailing Address
First Line	:	12705 TROWBRIDGE LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-4186
Country	:	US
Telephone Number	:	813-291-1245
Fax Number	:

Provider Business Practice Location Address
First Line	:	12705 TROWBRIDGE LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-4186
Country	:	US
Telephone Number	:	813-291-1245
Fax Number	:

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

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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Directions to “ YAQUELIN BLANCO GUERRA ” Practice Location

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