Provider Demographics
NPI:1144097445
Name:BLANCO LLANES, YUMAY
Entity type:Individual
Prefix:
First Name:YUMAY
Middle Name:
Last Name:BLANCO LLANES
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 1:2000 LUDLAM RD APT 15
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1880
Mailing Address - Country:US
Mailing Address - Phone:786-820-7076
Mailing Address - Fax:
Practice Address - Street 1:2000 LUDLAM RD APT 15
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1880
Practice Address - Country:US
Practice Address - Phone:786-820-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-312080106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty