Healthcare Provider Details

I. General information

NPI: 1568022788
Provider Name (Legal Business Name): YANIA FERNANDEZ CAMPOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 E 30TH ST
HIALEAH FL
33013-3329
US

IV. Provider business mailing address

658 E 30TH ST
HIALEAH FL
33013-3329
US

V. Phone/Fax

Practice location:
  • Phone: 786-413-4731
  • Fax:
Mailing address:
  • Phone: 786-413-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number126-89623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: