Provider Demographics
NPI:1790586105
Name:DETRINIDAD, YENI
Entity type:Individual
Prefix:
First Name:YENI
Middle Name:
Last Name:DETRINIDAD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 114TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-3410
Mailing Address - Country:US
Mailing Address - Phone:305-450-7464
Mailing Address - Fax:
Practice Address - Street 1:6225 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-6244
Practice Address - Country:US
Practice Address - Phone:941-708-2817
Practice Address - Fax:941-708-2819
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7143156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician