Provider Demographics
NPI:1093338436
Name:JURADO YANES, HARLEM
Entity Type:Individual
Prefix:
First Name:HARLEM
Middle Name:
Last Name:JURADO YANES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 MEDITERRANEAN BLVD APT 1806
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5750
Mailing Address - Country:US
Mailing Address - Phone:786-356-8368
Mailing Address - Fax:
Practice Address - Street 1:18220 MEDITERRANEAN BLVD APT 1806
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5750
Practice Address - Country:US
Practice Address - Phone:786-356-8368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-117234106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician