Provider Demographics
NPI:1134878895
Name:IZAGUIRRE CLEGER, YANITZA
Entity type:Individual
Prefix:
First Name:YANITZA
Middle Name:
Last Name:IZAGUIRRE CLEGER
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 1:7699 W 36TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1697
Mailing Address - Country:US
Mailing Address - Phone:786-320-4071
Mailing Address - Fax:
Practice Address - Street 1:7699 W 36TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-1697
Practice Address - Country:US
Practice Address - Phone:786-320-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-130707106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician