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General NPI Number Information
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NPI Number | 1255946729
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Entity Type | Individual
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Provider Name | YASMANI LLANES BASULTO
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Gender | Male
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 15924 SW 92ND AVE
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City | MIAMI
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State | FL
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Zip | 33157-1842
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Country | US
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Telephone | 305-964-5824
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Fax |
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Provider Business Mailing Address
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Address Line | 15300 SW 106TH TER APT 536
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City | MIAMI
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State | FL
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Zip | 33196-2749
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Country | US
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Telephone | 786-210-8380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH20752
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-43537
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License Number State | FL
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