Individual
YADIRA LICEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12030 SW 129TH CT STE 211, MIAMI, FL 33186-4584
(305) 639-8760
(786) 953-5144
Mailing address
15570 SW 57TH ST, MIAMI, FL 33193-2512
(786) 333-1099
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
CBHCM104537
FL
Other
Enumeration date
06/16/2022
Last updated
06/16/2022
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