MEDICARE: YVES CARMEN DORSAINVIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1245854686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVES CARMEN DORSAINVIL

Provider Business Mailing Address
First Line	:	631 SW SARDINIA AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3746
Country	:	US
Telephone Number	:	561-541-0059
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 SW SARDINIA AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3746
Country	:	US
Telephone Number	:	561-541-0059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	06/01/2020

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