Provider Demographics
NPI:1801663620
Name:GORRITA ALEJO, YANELI
Entity type:Individual
Prefix:
First Name:YANELI
Middle Name:
Last Name:GORRITA ALEJO
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 1:6861 W 4TH AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5357
Mailing Address - Country:US
Mailing Address - Phone:469-912-5040
Mailing Address - Fax:
Practice Address - Street 1:6861 W 4TH AVE APT 16
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5357
Practice Address - Country:US
Practice Address - Phone:469-912-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-312076106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty