Provider Demographics
NPI:1568282226
Name:MAINEGRA, YUNIOR
Entity type:Individual
Prefix:
First Name:YUNIOR
Middle Name:
Last Name:MAINEGRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SW 114TH AVE APT C5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1094
Mailing Address - Country:US
Mailing Address - Phone:786-991-3832
Mailing Address - Fax:
Practice Address - Street 1:710 SW 114TH AVE APT C5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1094
Practice Address - Country:US
Practice Address - Phone:786-991-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician