Provider Demographics
NPI:1033753868
Name:IGLESIAS VENTURA, YENIT M
Entity Type:Individual
Prefix:
First Name:YENIT
Middle Name:M
Last Name:IGLESIAS VENTURA
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 1:19371 NW 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2107
Mailing Address - Country:US
Mailing Address - Phone:786-672-9890
Mailing Address - Fax:
Practice Address - Street 1:3901 NW 79TH AVE STE 238
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6506
Practice Address - Country:US
Practice Address - Phone:305-320-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103493800Medicaid