Healthcare Provider Details

I. General information

NPI: 1043926553
Provider Name (Legal Business Name): YEZANA KIDS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/09/2025
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 GLADES ROAD SUITE 324A
BOCA RATON FL
33431
US

IV. Provider business mailing address

2255 GLADES ROAD SUITE 324A
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-0296
  • Fax: 561-269-6894
Mailing address:
  • Phone: 305-776-0296
  • Fax: 561-269-6894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. GULENKA BUERGO
Title or Position: PRESIDENT
Credential:
Phone: 305-776-0296