Provider Demographics
NPI:1558930321
Name:PEDRAZA, YUDENIA BARBARA
Entity type:Individual
Prefix:
First Name:YUDENIA
Middle Name:BARBARA
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YUDENIA
Other - Middle Name:BARBARA
Other - Last Name:PEDRAZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9950 SW 224TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1440
Mailing Address - Country:US
Mailing Address - Phone:786-734-9413
Mailing Address - Fax:
Practice Address - Street 1:9950 SW 224TH ST APT 206
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1440
Practice Address - Country:US
Practice Address - Phone:786-734-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-127016106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician