Provider Demographics
NPI:1659953677
Name:VALDIVIA LOYOLA, YAIMA Z
Entity Type:Individual
Prefix:
First Name:YAIMA
Middle Name:Z
Last Name:VALDIVIA LOYOLA
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 1:39962 HARMON GROVE CT
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-7380
Mailing Address - Country:US
Mailing Address - Phone:786-955-4669
Mailing Address - Fax:
Practice Address - Street 1:39962 HARMON GROVE CT
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-7380
Practice Address - Country:US
Practice Address - Phone:786-955-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-20-136337106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician