Healthcare Provider Details

I. General information

NPI: 1679381552
Provider Name (Legal Business Name): YENISEIDIS ESPINOSA TORNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 BIRMINGHAM DR
PALM BEACH GARDENS FL
33410-5927
US

IV. Provider business mailing address

9431 BIRMINGHAM DR
PALM BEACH GARDENS FL
33410-5927
US

V. Phone/Fax

Practice location:
  • Phone: 561-875-9965
  • Fax:
Mailing address:
  • Phone: 561-875-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-399151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: