Provider Demographics
NPI:1760085054
Name:GUIBERT TORREBLANCA, YULISANDRA
Entity Type:Individual
Prefix:MRS
First Name:YULISANDRA
Middle Name:
Last Name:GUIBERT TORREBLANCA
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 1:1128 CINNAMON WAY W
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6266
Mailing Address - Country:US
Mailing Address - Phone:786-357-4621
Mailing Address - Fax:
Practice Address - Street 1:1128 CINNAMON WAY W
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6266
Practice Address - Country:US
Practice Address - Phone:786-357-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician