1679378400 NPI number — MIRELYS YELENA PROENZA RODRIGUEZ RBT

Table of content: MIRELYS YELENA PROENZA RODRIGUEZ RBT (NPI 1679378400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679378400 NPI number — MIRELYS YELENA PROENZA RODRIGUEZ RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PROENZA RODRIGUEZ
Provider First Name:
MIRELYS
Provider Middle Name:
YELENA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679378400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 VIA LUGANO CIRCLE
Provider Second Line Business Mailing Address:
211 APT
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-720-3198
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 VIA LUGANO CIRCLE
Provider Second Line Business Practice Location Address:
211 APT
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-720-3198
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  P652-559-00-956-0 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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