Provider Demographics
NPI:1245546217
Name:CARDIN, YENNIFFER MARIA
Entity type:Individual
Prefix:
First Name:YENNIFFER
Middle Name:MARIA
Last Name:CARDIN
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 1:3900 NW 79TH AVE STE 429
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6548
Mailing Address - Country:US
Mailing Address - Phone:305-597-3696
Mailing Address - Fax:305-597-3698
Practice Address - Street 1:3900 NW 79TH AVE STE 429
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6548
Practice Address - Country:US
Practice Address - Phone:305-597-3696
Practice Address - Fax:305-597-3698
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45882225700000X
FL23329225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist