Provider Demographics
NPI:1306406129
Name:NIEBLA, YOSELIN (RBT)
Entity Type:Individual
Prefix:
First Name:YOSELIN
Middle Name:
Last Name:NIEBLA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6003
Mailing Address - Country:US
Mailing Address - Phone:509-440-2578
Mailing Address - Fax:
Practice Address - Street 1:1604 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6003
Practice Address - Country:US
Practice Address - Phone:509-440-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No183700000XPharmacy Service ProvidersPharmacy Technician