Provider Demographics
NPI:1376393751
Name:ALVAREZ TRUJILLO, YARIEL
Entity Type:Individual
Prefix:
First Name:YARIEL
Middle Name:
Last Name:ALVAREZ TRUJILLO
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 1:839 LIDO CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1839
Mailing Address - Country:US
Mailing Address - Phone:561-524-6388
Mailing Address - Fax:
Practice Address - Street 1:839 LIDO CIR APT 104
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-1839
Practice Address - Country:US
Practice Address - Phone:561-524-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-318587106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician