Provider Demographics
NPI:1841011640
Name:IZQUIERDO, YOANSY (CBHCM)
Entity type:Individual
Prefix:
First Name:YOANSY
Middle Name:
Last Name:IZQUIERDO
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:YOANSY
Other - Middle Name:
Other - Last Name:IZQUIERDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CBHCM
Mailing Address - Street 1:18501 NW 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-5328
Mailing Address - Country:US
Mailing Address - Phone:305-970-4170
Mailing Address - Fax:
Practice Address - Street 1:18501 NW 56TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-5328
Practice Address - Country:US
Practice Address - Phone:305-970-4170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0100271251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health