Provider Demographics
NPI:1962079236
Name:IZNAGA SORIA, YELENA
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:IZNAGA SORIA
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 1:6110 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-1372
Mailing Address - Country:US
Mailing Address - Phone:954-907-2604
Mailing Address - Fax:
Practice Address - Street 1:4160 W 16TH AVE STE 502
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5884
Practice Address - Country:US
Practice Address - Phone:786-401-7531
Practice Address - Fax:786-401-7532
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician