Provider Demographics
NPI:1003663899
Name:DE LA PUENTE, YAILEN YNFANTE
Entity type:Individual
Prefix:
First Name:YAILEN
Middle Name:YNFANTE
Last Name:DE LA PUENTE
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 1:755 W 29TH ST APT 107
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5640
Mailing Address - Country:US
Mailing Address - Phone:972-809-7395
Mailing Address - Fax:
Practice Address - Street 1:755 W 29TH ST APT 107
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5640
Practice Address - Country:US
Practice Address - Phone:972-809-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24321075106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician