MEDICARE: DR. YOLAIVYS VALCARCEL FUNDORA

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	122300000X	Dentist	DN20186	FL

General Provider Information

NPI Number	:	1285074112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOLAIVYS VALCARCEL FUNDORA

Provider Business Mailing Address
First Line	:	1875 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-5805
Country	:	US
Telephone Number	:	954-320-9555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1875 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-5805
Country	:	US
Telephone Number	:	954-320-9555
Fax Number	:

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

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	09/18/2019

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