Provider Demographics
NPI:1992212658
Name:PORTAL, YUDENY D (RBT)
Entity Type:Individual
Prefix:MISS
First Name:YUDENY
Middle Name:D
Last Name:PORTAL
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 1:5564 NW 200TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6628
Mailing Address - Country:US
Mailing Address - Phone:786-973-5183
Mailing Address - Fax:
Practice Address - Street 1:5564 NW 200TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-6628
Practice Address - Country:US
Practice Address - Phone:786-973-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician