Healthcare Provider Details

I. General information

NPI: 1730756792
Provider Name (Legal Business Name): YAMILET MOREJON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 W 4TH CT
HIALEAH FL
33012-5106
US

IV. Provider business mailing address

3361 W 4TH CT
HIALEAH FL
33012-5106
US

V. Phone/Fax

Practice location:
  • Phone: 305-812-9037
  • Fax:
Mailing address:
  • Phone: 305-812-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-125559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: