MEDICARE: YANEXY FONSECA

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

General Provider Information

NPI Number	:	1639904527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANEXY FONSECA

Provider Business Mailing Address
First Line	:	3982 NW 176TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3848
Country	:	US
Telephone Number	:	786-219-8182
Fax Number	:

Provider Business Practice Location Address
First Line	:	3982 NW 176TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3848
Country	:	US
Telephone Number	:	786-219-8182
Fax Number	:

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

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	09/03/2024

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Directions to “ YANEXY FONSECA ” Practice Location

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