Provider Demographics
NPI:1134915390
Name:GARCIA GUARDARRAMOS, YENISLEY
Entity type:Individual
Prefix:
First Name:YENISLEY
Middle Name:
Last Name:GARCIA GUARDARRAMOS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14957 SW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2056
Mailing Address - Country:US
Mailing Address - Phone:561-670-8261
Mailing Address - Fax:
Practice Address - Street 1:14957 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2056
Practice Address - Country:US
Practice Address - Phone:561-670-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-426029106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician