Provider Demographics
NPI:1174230346
Name:YANEZ PADIN, ELISA
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:YANEZ PADIN
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 1:6060 W 21ST CT APT 306
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2688
Mailing Address - Country:US
Mailing Address - Phone:954-681-8927
Mailing Address - Fax:
Practice Address - Street 1:6060 W 21ST CT APT 306
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2688
Practice Address - Country:US
Practice Address - Phone:954-681-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0104810171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator