Provider Demographics
NPI:1467044313
Name:PAREDES VELAZQUEZ, YADIRA PATRICIA
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:PATRICIA
Last Name:PAREDES VELAZQUEZ
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 1:830 S HOLLYBROOK DR APT 202
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4041
Mailing Address - Country:US
Mailing Address - Phone:786-399-0497
Mailing Address - Fax:
Practice Address - Street 1:830 S HOLLYBROOK DR APT 202
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4041
Practice Address - Country:US
Practice Address - Phone:786-399-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-153656106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician