Healthcare Provider Details

I. General information

NPI: 1184401598
Provider Name (Legal Business Name): YANETSY MAYELIN HERNANDEZ PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 SW 169TH LN
MIAMI FL
33187-1735
US

IV. Provider business mailing address

15031 SW 169TH LN
MIAMI FL
33187-1735
US

V. Phone/Fax

Practice location:
  • Phone: 786-793-4218
  • Fax:
Mailing address:
  • Phone: 786-793-4218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87994
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-278453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: