Provider Demographics
NPI:1114784592
Name:FREIJO SANTANA, YANEISY
Entity Type:Individual
Prefix:
First Name:YANEISY
Middle Name:
Last Name:FREIJO SANTANA
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 1:13205 SW 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5331
Mailing Address - Country:US
Mailing Address - Phone:786-290-9192
Mailing Address - Fax:180-060-3889
Practice Address - Street 1:13205 SW 137TH AVE STE 224-225
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5331
Practice Address - Country:US
Practice Address - Phone:786-290-9192
Practice Address - Fax:180-060-3889
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-326898106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician