Healthcare Provider Details

I. General information

NPI: 1386329225
Provider Name (Legal Business Name): JENNIFER YEPEZ SANZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 NW 36TH ST STE 319
DORAL FL
33166-6674
US

IV. Provider business mailing address

17021 N BAY RD
SUNNY ISLES BEACH FL
33160-3684
US

V. Phone/Fax

Practice location:
  • Phone: 786-287-4039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-23-270952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: