Provider Demographics
NPI:1023793833
Name:MUNOZ ZAMORA, YUSNEIVY
Entity type:Individual
Prefix:
First Name:YUSNEIVY
Middle Name:
Last Name:MUNOZ ZAMORA
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 1:398 SW LUCERO DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1900
Mailing Address - Country:US
Mailing Address - Phone:772-722-0742
Mailing Address - Fax:
Practice Address - Street 1:398 SW LUCERO DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1900
Practice Address - Country:US
Practice Address - Phone:772-722-0742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM525960977940106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician