Provider Demographics
NPI:1619696929
Name:YAJURE BARRERA, VERONICA J (ITDS)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:J
Last Name:YAJURE BARRERA
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 SW 108TH AVE APT C405
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8617
Mailing Address - Country:US
Mailing Address - Phone:786-597-0204
Mailing Address - Fax:
Practice Address - Street 1:10700 SW 108TH AVE APT C405
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8617
Practice Address - Country:US
Practice Address - Phone:786-597-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist