Provider Demographics
NPI:1003452061
Name:JORRIN, YACQUELIN MILAGROS
Entity type:Individual
Prefix:
First Name:YACQUELIN
Middle Name:MILAGROS
Last Name:JORRIN
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 1:10689 N KENDALL DR STE 309
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1525
Mailing Address - Country:US
Mailing Address - Phone:786-536-7470
Mailing Address - Fax:
Practice Address - Street 1:20121 SW 118TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-5463
Practice Address - Country:US
Practice Address - Phone:786-218-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-101046106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty