Provider Demographics
NPI:1366066029
Name:SERRANO GOMEZ, YANCARLOS (RBT)
Entity type:Individual
Prefix:MR
First Name:YANCARLOS
Middle Name:
Last Name:SERRANO GOMEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1153
Mailing Address - Country:US
Mailing Address - Phone:786-312-0645
Mailing Address - Fax:
Practice Address - Street 1:650 E 63RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1153
Practice Address - Country:US
Practice Address - Phone:786-312-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-119905106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician