MEDICARE: YALILYS MENA LLUESMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BCBA-1-24-71097	FL

General Provider Information

NPI Number	:	1205692639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YALILYS MENA LLUESMA

Provider Business Mailing Address
First Line	:	4198 W 18TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5803
Country	:	US
Telephone Number	:	786-881-1356
Fax Number	:

Provider Business Practice Location Address
First Line	:	4198 W 18TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5803
Country	:	US
Telephone Number	:	786-881-1356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2024
Last Update Date	:	02/23/2024

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