MEDICARE: MR. LUIS A. YANCE

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1700108677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS A. YANCE

Provider Business Mailing Address
First Line	:	3412 W 84TH ST STE 102
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4918
Country	:	US
Telephone Number	:	305-764-3755
Fax Number	:	305-764-3756

Provider Business Practice Location Address
First Line	:	3412 W 84TH ST STE 102
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4918
Country	:	US
Telephone Number	:	305-764-3755
Fax Number	:	305-764-3756

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

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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