Basic Information
| Provider Information | |||||||||
| NPI: | 1174820286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUERTO | ||||||||
| FirstName: | YILIANA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1321 MURFRESBORO PIKE STE 702 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372172679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039054427 | ||||||||
| FaxNumber: | 6155775661 | ||||||||
| Practice Location | |||||||||
| Address1: | 11411 NW 56TH DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330763122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547527571 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2011 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-12-12659 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1-12-12659 | 01 | FL | BEHAVIOR ANALYST CERTIFICATION BOARD | OTHER |