Provider Demographics
NPI:1306659701
Name:HERNANDEZ FONTICIELLA, YENIRA M
Entity type:Individual
Prefix:
First Name:YENIRA
Middle Name:M
Last Name:HERNANDEZ FONTICIELLA
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 1:18300 SW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1748
Mailing Address - Country:US
Mailing Address - Phone:645-214-1335
Mailing Address - Fax:
Practice Address - Street 1:18300 SW 100TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1748
Practice Address - Country:US
Practice Address - Phone:645-214-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-408859106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician