Healthcare Provider Details

I. General information

NPI: 1952182610
Provider Name (Legal Business Name): YADIRA E CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 SW 108TH AVE APT A202
MIAMI FL
33176-8625
US

IV. Provider business mailing address

10400 SW 108TH AVE APT A202
MIAMI FL
33176-8625
US

V. Phone/Fax

Practice location:
  • Phone: 305-495-7086
  • Fax:
Mailing address:
  • Phone: 305-495-7086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-294755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: