Provider Demographics
NPI:1417527474
Name:RANGEL VEULENS, YAMIRA
Entity Type:Individual
Prefix:
First Name:YAMIRA
Middle Name:
Last Name:RANGEL VEULENS
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 1:15560 NW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6902
Mailing Address - Country:US
Mailing Address - Phone:786-616-5425
Mailing Address - Fax:
Practice Address - Street 1:1275 W 47TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3394
Practice Address - Country:US
Practice Address - Phone:786-401-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-92827106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103796700Medicaid