Provider Demographics
NPI:1518646074
Name:SANTANA CORDOVES, YURISLEIDYS
Entity Type:Individual
Prefix:
First Name:YURISLEIDYS
Middle Name:
Last Name:SANTANA CORDOVES
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 1:2820 SW 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4832
Mailing Address - Country:US
Mailing Address - Phone:786-425-7570
Mailing Address - Fax:
Practice Address - Street 1:2820 SW 68TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4832
Practice Address - Country:US
Practice Address - Phone:786-425-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB792084106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician