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General NPI Number Information
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NPI Number | 1598352221
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Entity Type | Individual
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Provider Name | YULIANIS FUNDORA
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Gender | Female
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 25300 SW 115TH CT
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City | HOMESTEAD
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State | FL
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Zip | 33032-4723
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Country | US
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Telephone | 786-252-5774
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Fax |
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Provider Business Mailing Address
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Address Line | 10651 HAMMOCKS BLVD APT 812
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City | MIAMI
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State | FL
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Zip | 33196-3741
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Country | US
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Telephone | 786-252-5774
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 18754
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License Number State | FL
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