Provider Demographics
NPI:1407617673
Name:ACOSTA SALGADO, YISEL
Entity Type:Individual
Prefix:
First Name:YISEL
Middle Name:
Last Name:ACOSTA SALGADO
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 1:2210 S FORBES RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-8449
Mailing Address - Country:US
Mailing Address - Phone:813-562-7106
Mailing Address - Fax:
Practice Address - Street 1:2210 S FORBES RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-8449
Practice Address - Country:US
Practice Address - Phone:813-562-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician