Healthcare Provider Details

I. General information

NPI: 1770096935
Provider Name (Legal Business Name): YUDARIS FAVIER GIL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13930 SW 47TH ST STE 203
MIAMI FL
33175-4400
US

IV. Provider business mailing address

14807 SW 90TH TER
MIAMI FL
33196-1468
US

V. Phone/Fax

Practice location:
  • Phone: 786-534-7127
  • Fax:
Mailing address:
  • Phone: 832-732-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11050325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: