Healthcare Provider Details

I. General information

NPI: 1881403046
Provider Name (Legal Business Name): YASMIT PIEDRA SACRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GOODLETTE RD
NAPLES FL
34102-5614
US

IV. Provider business mailing address

506 FLAMINGO AVE S
LEHIGH ACRES FL
33974-0563
US

V. Phone/Fax

Practice location:
  • Phone: 239-316-7656
  • Fax:
Mailing address:
  • Phone: 239-219-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB885545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: