Provider Demographics
NPI:1982211801
Name:AVILA, YOHAN LEANDRO
Entity Type:Individual
Prefix:
First Name:YOHAN
Middle Name:LEANDRO
Last Name:AVILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 NW 43RD AVE APT 1L
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2603
Mailing Address - Country:US
Mailing Address - Phone:786-832-5663
Mailing Address - Fax:
Practice Address - Street 1:1202 NW 43RD AVE APT 1L
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2603
Practice Address - Country:US
Practice Address - Phone:786-832-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106589000Medicaid