Healthcare Provider Details

I. General information

NPI: 1104596477
Provider Name (Legal Business Name): YUSLEYVIS ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1982 E 4TH AVE
HIALEAH FL
33010-2714
US

IV. Provider business mailing address

1982 E 4TH AVE
HIALEAH FL
33010-2714
US

V. Phone/Fax

Practice location:
  • Phone: 786-409-3231
  • Fax: 786-409-3273
Mailing address:
  • Phone: 786-409-3231
  • Fax: 786-409-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRB-20-123258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: