Provider Demographics
NPI:1043809213
Name:AGUILERA PUPO, YAIMA
Entity Type:Individual
Prefix:
First Name:YAIMA
Middle Name:
Last Name:AGUILERA PUPO
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 1:5217 W 22ND CT APT 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-7051
Mailing Address - Country:US
Mailing Address - Phone:786-372-5314
Mailing Address - Fax:
Practice Address - Street 1:5217 W 22ND CT APT 102
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-7051
Practice Address - Country:US
Practice Address - Phone:786-372-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-138379106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109185200Medicaid