Healthcare Provider Details

I. General information

NPI: 1215892328
Provider Name (Legal Business Name): YENISEI VALDES VILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 SW 280TH ST APT 102
HOMESTEAD FL
33032-8378
US

IV. Provider business mailing address

14400 SW 280TH ST APT 102
HOMESTEAD FL
33032-8378
US

V. Phone/Fax

Practice location:
  • Phone: 786-763-4290
  • Fax:
Mailing address:
  • Phone: 786-763-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1055946
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: