Provider Demographics
NPI:1942878467
Name:SANTOYO PINON, YENISSEY (CBHCMS)
Entity Type:Individual
Prefix:
First Name:YENISSEY
Middle Name:
Last Name:SANTOYO PINON
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 PALMETTO FRNTG RD STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1568
Mailing Address - Country:US
Mailing Address - Phone:786-536-2945
Mailing Address - Fax:786-565-3955
Practice Address - Street 1:14100 PALMETTO FRNTG RD STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1568
Practice Address - Country:US
Practice Address - Phone:786-536-2945
Practice Address - Fax:786-565-3955
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110542500Medicaid