Provider Demographics
NPI:1225850431
Name:VERA MAIDIQUE, YISMEL MANUEL
Entity type:Individual
Prefix:
First Name:YISMEL
Middle Name:MANUEL
Last Name:VERA MAIDIQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2002
Mailing Address - Country:US
Mailing Address - Phone:786-212-6709
Mailing Address - Fax:
Practice Address - Street 1:2456 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2002
Practice Address - Country:US
Practice Address - Phone:786-212-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician