Provider Demographics
NPI:1821645938
Name:GUTIERREZ MUSE, YASMIN (RBT)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:GUTIERREZ MUSE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SE 14TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2133
Mailing Address - Country:US
Mailing Address - Phone:786-999-5589
Mailing Address - Fax:
Practice Address - Street 1:1312 SW 17TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2351
Practice Address - Country:US
Practice Address - Phone:239-373-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022408000Medicaid