Provider Demographics
NPI:1457953101
Name:ALVAREZ YANES, MIRAIDA
Entity Type:Individual
Prefix:
First Name:MIRAIDA
Middle Name:
Last Name:ALVAREZ YANES
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 1:3630 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4213
Mailing Address - Country:US
Mailing Address - Phone:786-768-4161
Mailing Address - Fax:
Practice Address - Street 1:3630 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4213
Practice Address - Country:US
Practice Address - Phone:786-768-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL416540707010103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst