MEDICARE: PREVENTIMED LLC

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	207Q00000X	Family Medicine Physician	ME0075005	FL

General Provider Information

NPI Number	:	1578015913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIMED LLC

Provider Business Mailing Address
First Line	:	1533 SUNSET DR
Second Line	:	SUITE 200
City	:	CORAL GABLES
State	:	FL
Zip	:	33143-5700
Country	:	US
Telephone Number	:	305-665-7666
Fax Number	:	305-663-7992

Provider Business Practice Location Address
First Line	:	1533 SUNSET DR
Second Line	:	SUITE 200
City	:	CORAL GABLES
State	:	FL
Zip	:	33143-5700
Country	:	US
Telephone Number	:	305-665-7666
Fax Number	:	305-663-7992

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES FERNANDO YANES
Credential	:	M.D
Telephone Number	:	305-665-7666

Provider Enumeration Date	:	11/02/2016
Last Update Date	:	11/02/2016

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