Healthcare Provider Details

I. General information

NPI: 1912758558
Provider Name (Legal Business Name): YILIAN B CRESPO MERAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 SW 171ST CT
MIAMI FL
33196-2978
US

IV. Provider business mailing address

9375 SW 171ST CT
MIAMI FL
33196-2978
US

V. Phone/Fax

Practice location:
  • Phone: 786-818-1097
  • Fax:
Mailing address:
  • Phone: 786-818-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-90014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: