Provider Demographics
NPI:1568137354
Name:SOTO MORENO, YAILIANY
Entity Type:Individual
Prefix:
First Name:YAILIANY
Middle Name:
Last Name:SOTO MORENO
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 1:19 DEL PRADO BLVD N STE I
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-6303
Mailing Address - Country:US
Mailing Address - Phone:239-205-6766
Mailing Address - Fax:
Practice Address - Street 1:9294 SAN CARLOS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-4914
Practice Address - Country:US
Practice Address - Phone:239-300-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst