Basic Information
Provider Information
NPI: 1487025359
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONZON
FirstName: YALILY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5804 W 26TH AVE
Address2:  
City: HIALEAH
State: FL
PostalCode: 330164010
CountryCode: US
TelephoneNumber: 7863592551
FaxNumber:  
Practice Location
Address1: 7392 NW 35TH TER
Address2:  
City: MIAMI
State: FL
PostalCode: 331221271
CountryCode: US
TelephoneNumber: 3055979494
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/16/2015
LastUpdateDate: 10/16/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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