Provider Demographics
NPI:1104492883
Name:RUIZ FELIPE, YADIRA
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:RUIZ FELIPE
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 1:827 SE 9TH AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5742
Mailing Address - Country:US
Mailing Address - Phone:305-244-8456
Mailing Address - Fax:
Practice Address - Street 1:827 SE 9TH AVE APT 2A
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5742
Practice Address - Country:US
Practice Address - Phone:305-244-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB659651106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBACB659651Medicaid