Provider Demographics
NPI:1922578939
Name:CABANES, YENISLEIDYS
Entity Type:Individual
Prefix:
First Name:YENISLEIDYS
Middle Name:
Last Name:CABANES
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 1:5916 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4561
Mailing Address - Country:US
Mailing Address - Phone:305-528-9970
Mailing Address - Fax:
Practice Address - Street 1:5916 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-4561
Practice Address - Country:US
Practice Address - Phone:305-528-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022823400Medicaid