Provider Demographics
NPI:1912602947
Name:ESTRADA NAPOLES, IYOLEIVYS
Entity type:Individual
Prefix:
First Name:IYOLEIVYS
Middle Name:
Last Name:ESTRADA NAPOLES
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 1:2996 SW BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3207
Mailing Address - Country:US
Mailing Address - Phone:832-995-9763
Mailing Address - Fax:
Practice Address - Street 1:6383 10TH AVE N
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-1689
Practice Address - Country:US
Practice Address - Phone:561-429-5794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-264499106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty