Provider Demographics
NPI:1073049011
Name:AVILA MENA, YENERIS
Entity Type:Individual
Prefix:
First Name:YENERIS
Middle Name:
Last Name:AVILA MENA
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 1:57 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6262
Mailing Address - Country:US
Mailing Address - Phone:786-288-6616
Mailing Address - Fax:
Practice Address - Street 1:57 NE 12TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6262
Practice Address - Country:US
Practice Address - Phone:786-288-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst