MEDICARE: YAIRIMAR CORDERO VAZQUEZ

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
2	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1598483760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAIRIMAR CORDERO VAZQUEZ

Provider Business Mailing Address
First Line	:	16326 MACON ST APT 112
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34714-6562
Country	:	US
Telephone Number	:	407-607-7356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1939 MAGUIRE RD STE 107-108
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-7942
Country	:	US
Telephone Number	:	407-473-8005
Fax Number	:

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

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/22/2024

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Directions to “ YAIRIMAR CORDERO VAZQUEZ ” Practice Location

Language	Start Address	Practice Location

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