Healthcare Provider Details

I. General information

NPI: 1962079236
Provider Name (Legal Business Name): YELENA IZNAGA SORIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 W 16TH AVE STE 502
HIALEAH FL
33012-5884
US

IV. Provider business mailing address

6110 JEFFERSON ST
HOLLYWOOD FL
33023-1372
US

V. Phone/Fax

Practice location:
  • Phone: 786-401-7531
  • Fax: 786-401-7532
Mailing address:
  • Phone: 954-907-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: