Provider Demographics
NPI:1235919549
Name:CANTILLO, YANIEL
Entity Type:Individual
Prefix:
First Name:YANIEL
Middle Name:
Last Name:CANTILLO
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 1:1860 CORAL WAY APT 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2746
Mailing Address - Country:US
Mailing Address - Phone:786-988-3464
Mailing Address - Fax:
Practice Address - Street 1:1801 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2790
Practice Address - Country:US
Practice Address - Phone:786-866-5914
Practice Address - Fax:787-529-1939
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23300836106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician