Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | FL |
NPI | 1003280058 |
---|---|
Provider Name | Yana Ustsinovich |
First Address | Doral, FL 33172-5925 |
Second Address | Doral, FL 33172-5925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2015 |
Last Update Date | 22/12/2015 |