Provider Demographics
NPI:1528898673
Name:SALLES ESPINOSA, YRAIDA
Entity type:Individual
Prefix:
First Name:YRAIDA
Middle Name:
Last Name:SALLES ESPINOSA
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 1:7518 N COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3117
Mailing Address - Country:US
Mailing Address - Phone:656-203-1434
Mailing Address - Fax:
Practice Address - Street 1:7518 N COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3117
Practice Address - Country:US
Practice Address - Phone:656-203-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician