Provider Demographics
NPI:1881420388
Name:POVEDA CASTRO, YUDENIA DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:YUDENIA
Middle Name:DE LA CARIDAD
Last Name:POVEDA CASTRO
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 1:8410 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1717
Mailing Address - Country:US
Mailing Address - Phone:786-387-4400
Mailing Address - Fax:
Practice Address - Street 1:8410 WOODLAKE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1717
Practice Address - Country:US
Practice Address - Phone:786-387-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-331138106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician