MEDICARE: YAIDELIN CANAVES PERALTA

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	24361647	FL

General Provider Information

NPI Number	:	1912735887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAIDELIN CANAVES PERALTA

Provider Business Mailing Address
First Line	:	8936 NW 112TH ST
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4578
Country	:	US
Telephone Number	:	786-879-3186
Fax Number	:

Provider Business Practice Location Address
First Line	:	8936 NW 112TH ST
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4578
Country	:	US
Telephone Number	:	786-879-3186
Fax Number	:

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

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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Directions to “ YAIDELIN CANAVES PERALTA ” Practice Location

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