Provider Demographics
NPI:1710617709
Name:BALLESTEROS ORIVE, YANIA (RBT-1987282)
Entity Type:Individual
Prefix:
First Name:YANIA
Middle Name:
Last Name:BALLESTEROS ORIVE
Suffix:
Gender:F
Credentials:RBT-1987282
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 EL JARDIN DR APT 10
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2370
Mailing Address - Country:US
Mailing Address - Phone:786-234-7024
Mailing Address - Fax:
Practice Address - Street 1:3316 EL JARDIN DR APT 10
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2370
Practice Address - Country:US
Practice Address - Phone:786-234-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB423960848150106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician