Provider Demographics
NPI:1154955763
Name:BOADA HUNG, YESSIKA
Entity type:Individual
Prefix:
First Name:YESSIKA
Middle Name:
Last Name:BOADA HUNG
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 1:11010 SW 125TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4575
Mailing Address - Country:US
Mailing Address - Phone:786-720-8472
Mailing Address - Fax:
Practice Address - Street 1:11010 SW 125TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-4575
Practice Address - Country:US
Practice Address - Phone:786-720-8472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCABA-0-19-10568106E00000X
FL1-20-44913103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst