Provider Demographics
NPI:1992215875
Name:VINELO, YESSICA I
Entity Type:Individual
Prefix:
First Name:YESSICA
Middle Name:
Last Name:VINELO
Suffix:I
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 1:15251 SW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2559
Mailing Address - Country:US
Mailing Address - Phone:786-499-3598
Mailing Address - Fax:
Practice Address - Street 1:15251 SW 61ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2559
Practice Address - Country:US
Practice Address - Phone:786-499-3598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16261Medicaid
FL162161Medicaid