Provider Demographics
NPI:1568018794
Name:YANES, JOHN PAUL
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:YANES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 SW 107TH AVE APT 1004
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7357
Mailing Address - Country:US
Mailing Address - Phone:305-815-8558
Mailing Address - Fax:
Practice Address - Street 1:1911 SW 107TH AVE APT 1004
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7357
Practice Address - Country:US
Practice Address - Phone:305-815-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-91638106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician