Provider Demographics
NPI:1306672886
Name:PINO HENRIQUEZ, YADIRA LILIA
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:LILIA
Last Name:PINO HENRIQUEZ
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 1:11315 SW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5549
Mailing Address - Country:US
Mailing Address - Phone:786-804-0165
Mailing Address - Fax:
Practice Address - Street 1:11315 SW 47TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5549
Practice Address - Country:US
Practice Address - Phone:786-804-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-375067106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician