Provider Demographics
NPI:1598483760
Name:CORDERO VAZQUEZ, YAIRIMAR
Entity type:Individual
Prefix:
First Name:YAIRIMAR
Middle Name:
Last Name:CORDERO VAZQUEZ
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 1:16326 MACON ST APT 112
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6562
Mailing Address - Country:US
Mailing Address - Phone:407-607-7356
Mailing Address - Fax:
Practice Address - Street 1:1939 MAGUIRE RD STE 107-108
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-7942
Practice Address - Country:US
Practice Address - Phone:407-473-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician