Healthcare Provider Details

I. General information

NPI: 1609603612
Provider Name (Legal Business Name): YINELSA FREIRE VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13155 SW 134TH ST STE 202
MIAMI FL
33186-4488
US

IV. Provider business mailing address

10227 SW 24TH ST APT B128
MIAMI FL
33165-2579
US

V. Phone/Fax

Practice location:
  • Phone: 786-504-3119
  • Fax: 954-206-2835
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-357745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: