Provider Demographics
NPI:1356025696
Name:THEIS ORTEGA, NINOSKA YADIRA
Entity type:Individual
Prefix:
First Name:NINOSKA
Middle Name:YADIRA
Last Name:THEIS ORTEGA
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 1:6950 NW 186TH ST APT 310
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3290
Mailing Address - Country:US
Mailing Address - Phone:786-365-9417
Mailing Address - Fax:
Practice Address - Street 1:6950 NW 186TH ST APT 310
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3290
Practice Address - Country:US
Practice Address - Phone:786-365-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-277198106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician