Provider Demographics
NPI:1326867706
Name:BRESO ROSARIO, YENIFER
Entity type:Individual
Prefix:
First Name:YENIFER
Middle Name:
Last Name:BRESO ROSARIO
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 1:3995 SW 108TH AVE APT W16
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4471
Mailing Address - Country:US
Mailing Address - Phone:786-881-5306
Mailing Address - Fax:
Practice Address - Street 1:3995 SW 108TH AVE APT W16
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4471
Practice Address - Country:US
Practice Address - Phone:786-881-5306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician