Provider Demographics
NPI:1629420906
Name:GUERRA RAILLO, ROSIRIS YADIRA
Entity Type:Individual
Prefix:
First Name:ROSIRIS
Middle Name:YADIRA
Last Name:GUERRA RAILLO
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 1:19330 NW 5TH ST # TS
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3245
Mailing Address - Country:US
Mailing Address - Phone:786-322-9323
Mailing Address - Fax:
Practice Address - Street 1:19330 NW 5TH ST # TS
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3245
Practice Address - Country:US
Practice Address - Phone:786-322-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA-1-21-48567103K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst