Healthcare Provider Details

I. General information

NPI: 1396213955
Provider Name (Legal Business Name): YELENA TATIANA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27452 AMELIA ISLE CT
WESLEY CHAPEL FL
33544-6678
US

IV. Provider business mailing address

27452 AMELIA ISLE CT
WESLEY CHAPEL FL
33544-6678
US

V. Phone/Fax

Practice location:
  • Phone: 786-491-9858
  • Fax:
Mailing address:
  • Phone: 786-491-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-71390
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: