Provider Demographics
NPI:1831959717
Name:HERNANDEZ MOYA, YULEISY
Entity type:Individual
Prefix:MRS
First Name:YULEISY
Middle Name:
Last Name:HERNANDEZ MOYA
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 1:8029 LAKE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7716
Mailing Address - Country:US
Mailing Address - Phone:786-318-1141
Mailing Address - Fax:
Practice Address - Street 1:8029 LAKE DR APT 202
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-7716
Practice Address - Country:US
Practice Address - Phone:786-318-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-333607106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician