Provider Demographics
NPI:1285138511
Name:RUIZ MAYEDO, YANELYS MALLELIN
Entity type:Individual
Prefix:MISS
First Name:YANELYS
Middle Name:MALLELIN
Last Name:RUIZ MAYEDO
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 1:2600 SW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1227
Mailing Address - Country:US
Mailing Address - Phone:786-539-9208
Mailing Address - Fax:
Practice Address - Street 1:2600 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1227
Practice Address - Country:US
Practice Address - Phone:786-539-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician