Provider Demographics
NPI:1528569993
Name:LISCANO TORREALBA, YENYRETH (LPN, SA-C, SKINCARE)
Entity Type:Individual
Prefix:
First Name:YENYRETH
Middle Name:
Last Name:LISCANO TORREALBA
Suffix:
Gender:F
Credentials:LPN, SA-C, SKINCARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 NE 22ND ST APT 3103N
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5194
Mailing Address - Country:US
Mailing Address - Phone:786-205-7894
Mailing Address - Fax:
Practice Address - Street 1:425 NE 22ND ST APT 3103N
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5194
Practice Address - Country:US
Practice Address - Phone:786-205-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-147246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant