Healthcare Provider Details

I. General information

NPI: 1760106496
Provider Name (Legal Business Name): YENSY LAZA CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 SW 17TH PL APT 206
CAPE CORAL FL
33991-2375
US

IV. Provider business mailing address

1414 SW 17TH PL APT 206
CAPE CORAL FL
33991-2375
US

V. Phone/Fax

Practice location:
  • Phone: 239-233-0431
  • Fax:
Mailing address:
  • Phone: 239-233-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-235446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: