Provider Demographics
NPI:1902416449
Name:PADRON, YURI ALBERTO
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:ALBERTO
Last Name:PADRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5238 JOHNS ST
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8733
Mailing Address - Country:US
Mailing Address - Phone:239-200-8018
Mailing Address - Fax:
Practice Address - Street 1:5238 JOHNS ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8733
Practice Address - Country:US
Practice Address - Phone:239-200-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20122588106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician