Healthcare Provider Details

I. General information

NPI: 1396468948
Provider Name (Legal Business Name): YANEISY MARIA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4964 N PALM AVE
WINTER PARK FL
32792-9111
US

IV. Provider business mailing address

5772 NW LYNN CT
PORT SAINT LUCIE FL
34986-4109
US

V. Phone/Fax

Practice location:
  • Phone: 321-228-3776
  • Fax:
Mailing address:
  • Phone: 772-204-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: