Provider Demographics
NPI:1780435255
Name:DAVILA LOPEZ, YELENNI
Entity type:Individual
Prefix:
First Name:YELENNI
Middle Name:
Last Name:DAVILA LOPEZ
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 1:8181 NW SOUTH RIVER DR LOT E513
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7485
Mailing Address - Country:US
Mailing Address - Phone:786-337-2258
Mailing Address - Fax:
Practice Address - Street 1:8181 NW SOUTH RIVER DR LOT E513
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-7485
Practice Address - Country:US
Practice Address - Phone:786-337-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-332619106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician