MEDICARE: YALILE ELENA HERNANDEZ MARTIN

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1386155638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YALILE ELENA HERNANDEZ MARTIN

Provider Business Mailing Address
First Line	:	200 177TH DR APT 416
Second Line	:
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-2844
Country	:	US
Telephone Number	:	786-262-6017
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 177TH DR APT 416
Second Line	:
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-2844
Country	:	US
Telephone Number	:	786-262-6017
Fax Number	:

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

Provider Enumeration Date	:	10/13/2017
Last Update Date	:	10/13/2017

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