Provider Demographics
NPI:1063946630
Name:YATIV, NOAM
Entity type:Individual
Prefix:
First Name:NOAM
Middle Name:
Last Name:YATIV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21224 NE 19TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1515
Mailing Address - Country:US
Mailing Address - Phone:305-342-9982
Mailing Address - Fax:
Practice Address - Street 1:21224 NE 19TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-1515
Practice Address - Country:US
Practice Address - Phone:305-342-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst