Healthcare Provider Details

I. General information

NPI: 1730098138
Provider Name (Legal Business Name): YANET IZAGUIRRE CANDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4729 CHATTERTON WAY
RIVERVIEW FL
33578-3022
US

IV. Provider business mailing address

9212 WATOLLA DR
THONOTOSASSA FL
33592-3130
US

V. Phone/Fax

Practice location:
  • Phone: 702-472-5363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: