Healthcare Provider Details

I. General information

NPI: 1285565846
Provider Name (Legal Business Name): YEDELMYS BAEZ CAZOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 SW 94TH PL
MIAMI FL
33173-1534
US

IV. Provider business mailing address

5700 SW 94TH PL
MIAMI FL
33173-1534
US

V. Phone/Fax

Practice location:
  • Phone: 786-675-0417
  • Fax: 786-675-0417
Mailing address:
  • Phone: 786-675-0417
  • Fax: 786-675-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-539307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: