Provider Demographics
NPI:1104470947
Name:PRENDES HERNANDEZ, YASLEIDI
Entity type:Individual
Prefix:
First Name:YASLEIDI
Middle Name:
Last Name:PRENDES HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11830 SW 208TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7010
Mailing Address - Country:US
Mailing Address - Phone:305-302-7232
Mailing Address - Fax:
Practice Address - Street 1:11830 SW 208TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7010
Practice Address - Country:US
Practice Address - Phone:305-302-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-54501106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty