Provider Demographics
NPI:1801245592
Name:PUPO PADILLA, YANEIXI (BCBA)
Entity type:Individual
Prefix:
First Name:YANEIXI
Middle Name:
Last Name:PUPO PADILLA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 SE 5TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5413
Mailing Address - Country:US
Mailing Address - Phone:786-768-5232
Mailing Address - Fax:
Practice Address - Street 1:751 SE 5TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5413
Practice Address - Country:US
Practice Address - Phone:786-768-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-17-8056106E00000X
FL1-20-41139103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst