MEDICARE: YELAYNE YBARRA PEREZ

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

General Provider Information

NPI Number	:	1326777897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELAYNE YBARRA PEREZ

Provider Business Mailing Address
First Line	:	16701 E EPSON DR
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-4168
Country	:	US
Telephone Number	:	561-577-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 PALM LAKES BLVD
Second Line	:	SUITE-304E
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33470-4168
Country	:	US
Telephone Number	:	954-734-4708
Fax Number	:

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

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	09/09/2022

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