MEDICARE: YIRENE PENATE ALONSO

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

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	:	1649629247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YIRENE PENATE ALONSO

Provider Business Mailing Address
First Line	:	7855 NW 12 TH STREET #117
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14211 SW 147TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-4654
Country	:	US
Telephone Number	:	786-458-6459
Fax Number	:

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

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	06/06/2016

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Directions to “ YIRENE PENATE ALONSO ” Practice Location

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