Provider Demographics
NPI:1235996984
Name:MARTIN DURAN, YANDY
Entity Type:Individual
Prefix:
First Name:YANDY
Middle Name:
Last Name:MARTIN DURAN
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 1:7830 W 28TH AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7205
Mailing Address - Country:US
Mailing Address - Phone:386-264-9866
Mailing Address - Fax:
Practice Address - Street 1:7830 W 28TH AVE APT 204
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-7205
Practice Address - Country:US
Practice Address - Phone:386-264-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-327642106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty