Provider Demographics
NPI:1427811967
Name:HERNANDEZ CHAVEZ, YARISLEY
Entity type:Individual
Prefix:
First Name:YARISLEY
Middle Name:
Last Name:HERNANDEZ CHAVEZ
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 1:18850 NW 57TH AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7020
Mailing Address - Country:US
Mailing Address - Phone:786-440-8443
Mailing Address - Fax:
Practice Address - Street 1:480 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4542
Practice Address - Country:US
Practice Address - Phone:786-343-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-322349106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician