Provider Demographics
NPI:1215774773
Name:BLANCO SUAREZ, YUSLEIDY
Entity type:Individual
Prefix:
First Name:YUSLEIDY
Middle Name:
Last Name:BLANCO SUAREZ
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 1:660 N PERVIZ AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3030
Mailing Address - Country:US
Mailing Address - Phone:561-800-5031
Mailing Address - Fax:
Practice Address - Street 1:660 N PERVIZ AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3030
Practice Address - Country:US
Practice Address - Phone:561-800-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-351957106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician