Provider Demographics
NPI:1205692639
Name:MENA LLUESMA, YALILYS
Entity type:Individual
Prefix:
First Name:YALILYS
Middle Name:
Last Name:MENA LLUESMA
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 1:4198 W 18TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5803
Mailing Address - Country:US
Mailing Address - Phone:786-881-1356
Mailing Address - Fax:
Practice Address - Street 1:4198 W 18TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5803
Practice Address - Country:US
Practice Address - Phone:786-881-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA-1-24-71097103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty