Provider Demographics
NPI:1609589126
Name:SOLANO QUINZAN, YAILEN
Entity Type:Individual
Prefix:
First Name:YAILEN
Middle Name:
Last Name:SOLANO QUINZAN
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 1:217 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2254
Mailing Address - Country:US
Mailing Address - Phone:786-992-6021
Mailing Address - Fax:
Practice Address - Street 1:217 E 43RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-2254
Practice Address - Country:US
Practice Address - Phone:786-992-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-225349106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician