Healthcare Provider Details

I. General information

NPI: 1639969793
Provider Name (Legal Business Name): YILIAN FUENTES FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 ODIN ST
SPRING HILL FL
34608-3125
US

IV. Provider business mailing address

4355 ODIN ST
SPRING HILL FL
34608-3125
US

V. Phone/Fax

Practice location:
  • Phone: 813-699-2815
  • Fax:
Mailing address:
  • Phone: 813-699-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-434881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: