Provider Demographics
NPI:1659046662
Name:LORENZO, YAMILE
Entity Type:Individual
Prefix:
First Name:YAMILE
Middle Name:
Last Name:LORENZO
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 1:922 SW 68TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4723
Mailing Address - Country:US
Mailing Address - Phone:786-216-8803
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST STE 421
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6686
Practice Address - Country:US
Practice Address - Phone:305-320-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108426400Medicaid