MEDICARE: MRS. YAQUELIN LOPEZ SANTOS

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	25-490010	FL

General Provider Information

NPI Number	:	1982564548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YAQUELIN LOPEZ SANTOS

Provider Business Mailing Address
First Line	:	8851 NW 119TH ST UNIT 4216
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-7914
Country	:	US
Telephone Number	:	786-578-6476
Fax Number	:

Provider Business Practice Location Address
First Line	:	8851 NW 119TH ST UNIT 4216
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-7914
Country	:	US
Telephone Number	:	786-578-6476
Fax Number	:

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

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	11/17/2025

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