Healthcare Provider Details

I. General information

NPI: 1568051811
Provider Name (Legal Business Name): YENNIS VALDIVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY
FORT MYERS FL
33919-5188
US

IV. Provider business mailing address

3030 NW 3RD PL
CAPE CORAL FL
33993-6712
US

V. Phone/Fax

Practice location:
  • Phone: 786-597-6597
  • Fax:
Mailing address:
  • Phone: 786-597-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: