Healthcare Provider Details

I. General information

NPI: 1740700806
Provider Name (Legal Business Name): YANISEL PINEIRO CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 SW 155TH PL
MIAMI FL
33185-4140
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 116
DORAL FL
33122-1075
US

V. Phone/Fax

Practice location:
  • Phone: 786-518-6040
  • Fax:
Mailing address:
  • Phone: 305-591-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: