Provider Demographics
NPI:1396524591
Name:BOSQUE OBREGON, DENISES YOLAISIS
Entity type:Individual
Prefix:
First Name:DENISES
Middle Name:YOLAISIS
Last Name:BOSQUE OBREGON
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 1:7443 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5331
Mailing Address - Country:US
Mailing Address - Phone:754-267-8040
Mailing Address - Fax:
Practice Address - Street 1:7443 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5331
Practice Address - Country:US
Practice Address - Phone:754-267-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician