Healthcare Provider Details

I. General information

NPI: 1063019438
Provider Name (Legal Business Name): YANET AVILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YANET VEGA

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11402 NW 41ST ST UNIT 206
DORAL FL
33178-4859
US

IV. Provider business mailing address

11402 NW 41ST ST UNIT 206
DORAL FL
33178-4859
US

V. Phone/Fax

Practice location:
  • Phone: 786-875-7555
  • Fax: 305-373-3474
Mailing address:
  • Phone: 305-373-3424
  • Fax: 305-373-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-410242
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: