Healthcare Provider Details

I. General information

NPI: 1598474025
Provider Name (Legal Business Name): YANETSY OQUENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12853 SW 146TH LN
MIAMI FL
33186-6354
US

IV. Provider business mailing address

12853 SW 146TH LN
MIAMI FL
33186-6354
US

V. Phone/Fax

Practice location:
  • Phone: 786-768-0439
  • Fax:
Mailing address:
  • Phone: 786-768-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number19106299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: