Provider Demographics
NPI:1457864019
Name:MARTINEZ VASALLO, YANILEISY
Entity Type:Individual
Prefix:
First Name:YANILEISY
Middle Name:
Last Name:MARTINEZ VASALLO
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 1:12744 SW 261ST TER
Mailing Address - Street 2:
Mailing Address - City:NARANJA
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6901
Mailing Address - Country:US
Mailing Address - Phone:786-389-0133
Mailing Address - Fax:
Practice Address - Street 1:12744 SW 261ST TER
Practice Address - Street 2:
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-6901
Practice Address - Country:US
Practice Address - Phone:786-389-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician