Provider Demographics
NPI:1144012634
Name:MONTANDON, YESENIA
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:MONTANDON
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 1:17770 SW 107TH AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-0823
Mailing Address - Country:US
Mailing Address - Phone:786-362-4651
Mailing Address - Fax:
Practice Address - Street 1:17770 SW 107TH AVE APT 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-0823
Practice Address - Country:US
Practice Address - Phone:786-362-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-432392106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician