Provider Demographics
NPI:1003662487
Name:MUNOZ MORA, YANELA (IMH)
Entity type:Individual
Prefix:
First Name:YANELA
Middle Name:
Last Name:MUNOZ MORA
Suffix:
Gender:F
Credentials:IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1234
Mailing Address - Country:US
Mailing Address - Phone:305-619-3202
Mailing Address - Fax:305-463-6693
Practice Address - Street 1:1425 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1234
Practice Address - Country:US
Practice Address - Phone:305-619-3202
Practice Address - Fax:305-463-6693
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty