MEDICARE: YESENIA D TORRES BUSTILLO

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	106E00000X	Assistant Behavior Analyst	0-20-11401	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316541410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESENIA D TORRES BUSTILLO

Provider Business Mailing Address
First Line	:	8260 WILLOW BEACH DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-4111
Country	:	US
Telephone Number	:	786-537-4351
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2945
Country	:	US
Telephone Number	:	813-644-6538
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	03/05/2026

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