Provider Demographics
NPI:1487305900
Name:RODRIGUEZ VALDES, YAMILIS
Entity type:Individual
Prefix:
First Name:YAMILIS
Middle Name:
Last Name:RODRIGUEZ VALDES
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 1:26300 SW 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-2061
Mailing Address - Country:US
Mailing Address - Phone:786-758-7167
Mailing Address - Fax:
Practice Address - Street 1:26300 SW 162ND AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33031-2061
Practice Address - Country:US
Practice Address - Phone:786-758-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-158017106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician