Provider Demographics
NPI:1952145401
Name:TREJOS-DIAZ, YURITZI YANISBELL (RBT-23-287428)
Entity type:Individual
Prefix:
First Name:YURITZI
Middle Name:YANISBELL
Last Name:TREJOS-DIAZ
Suffix:
Gender:F
Credentials:RBT-23-287428
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3918 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2624
Mailing Address - Country:US
Mailing Address - Phone:813-567-6867
Mailing Address - Fax:
Practice Address - Street 1:3104 W WATERS AVE STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2877
Practice Address - Country:US
Practice Address - Phone:813-265-4439
Practice Address - Fax:813-513-0065
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRBR-23287428106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician