MEDICARE: YAIMA SOUTUYO

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

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	:	1568906196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAIMA SOUTUYO

Provider Business Mailing Address
First Line	:	10090 NW 80TH CT APT 1427
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2242
Country	:	US
Telephone Number	:	786-286-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	10090 NW 80TH CT APT 1427
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2242
Country	:	US
Telephone Number	:	786-286-8483
Fax Number	:

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

Provider Enumeration Date	:	12/16/2016
Last Update Date	:	12/16/2016

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Directions to “ YAIMA SOUTUYO ” Practice Location

Language	Start Address	Practice Location

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