Provider Demographics
NPI:1922614445
Name:MAZPULE, YOUSI
Entity Type:Individual
Prefix:
First Name:YOUSI
Middle Name:
Last Name:MAZPULE
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 1:17543 NW 66TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4432
Mailing Address - Country:US
Mailing Address - Phone:786-597-8389
Mailing Address - Fax:
Practice Address - Street 1:9102 NW 148TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-7314
Practice Address - Country:US
Practice Address - Phone:786-597-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty