MEDICARE: YAILIANY SOTO MORENO

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568137354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAILIANY SOTO MORENO

Provider Business Mailing Address
First Line	:	19 DEL PRADO BLVD N STE I
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-6303
Country	:	US
Telephone Number	:	239-205-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	9294 SAN CARLOS BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-4914
Country	:	US
Telephone Number	:	239-300-3207
Fax Number	:

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

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	08/12/2021

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Directions to “ YAILIANY SOTO MORENO ” Practice Location

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