MEDICARE: YUNAISY LOPEZ ACOSTA

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	RBT-24-367255	FL

General Provider Information

NPI Number	:	1881411890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUNAISY LOPEZ ACOSTA

Provider Business Mailing Address
First Line	:	2213 SE MERRILL RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7026
Country	:	US
Telephone Number	:	786-440-4353
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 SE MERRILL RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7026
Country	:	US
Telephone Number	:	786-440-4353
Fax Number	:

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

Provider Enumeration Date	:	09/21/2024
Last Update Date	:	09/21/2024

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