Provider Demographics
NPI:1124728787
Name:PADRON FALLS, YAMILKA
Entity type:Individual
Prefix:
First Name:YAMILKA
Middle Name:
Last Name:PADRON FALLS
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 1:7210 N MANHATTAN AVE APT 521
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3750
Mailing Address - Country:US
Mailing Address - Phone:813-316-5625
Mailing Address - Fax:
Practice Address - Street 1:7210 N MANHATTAN AVE APT 521
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3750
Practice Address - Country:US
Practice Address - Phone:813-316-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty