Provider Demographics
NPI:1396461703
Name:AVILA AGUILAR, YAREMIS (BACB765855)
Entity type:Individual
Prefix:
First Name:YAREMIS
Middle Name:
Last Name:AVILA AGUILAR
Suffix:
Gender:F
Credentials:BACB765855
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 LEMBERTON CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3580
Mailing Address - Country:US
Mailing Address - Phone:407-504-8631
Mailing Address - Fax:
Practice Address - Street 1:2412 LEMBERTON CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3580
Practice Address - Country:US
Practice Address - Phone:407-504-8631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-225710106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115229100OtherMEDICAID PROVIDER