Healthcare Provider Details

I. General information

NPI: 1457119422
Provider Name (Legal Business Name): YESSICA ZEQUEIRA BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 NW 26TH AVE # SVE
MIAMI FL
33125-3044
US

IV. Provider business mailing address

616 NW 26TH AVE APT 203
MIAMI FL
33125-3045
US

V. Phone/Fax

Practice location:
  • Phone: 786-817-5796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2829157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: