Provider Demographics
NPI:1063019438
Name:AVILA, YANET
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:AVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YANET
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8323 NW 12TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1840
Mailing Address - Country:US
Mailing Address - Phone:305-373-3424
Mailing Address - Fax:305-373-3474
Practice Address - Street 1:11402 NW 41ST ST UNIT 206
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4859
Practice Address - Country:US
Practice Address - Phone:786-875-7555
Practice Address - Fax:305-373-3474
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator