Healthcare Provider Details

I. General information

NPI: 1578491718
Provider Name (Legal Business Name): YARELIS GAITAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE
DORAL FL
33122-1073
US

IV. Provider business mailing address

8353 LAKE DR APT 205
DORAL FL
33166-7723
US

V. Phone/Fax

Practice location:
  • Phone: 305-602-5002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: