Healthcare Provider Details

I. General information

NPI: 1669121653
Provider Name (Legal Business Name): YENIS SUAREZ HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7971 RIVIERA BLVD STE 203
MIRAMAR FL
33023-6446
US

IV. Provider business mailing address

1540 HAMMOCK LN
PEMBROKE PINES FL
33026-3212
US

V. Phone/Fax

Practice location:
  • Phone: 786-508-3245
  • Fax: 561-634-2814
Mailing address:
  • Phone: 305-300-7531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-136428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: