Healthcare Provider Details

I. General information

NPI: 1669280053
Provider Name (Legal Business Name): YAMILE DE LOS ANGELES GUEVARA PORTELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 NW 82ND AVE STE 400-2
DORAL FL
33166-6652
US

IV. Provider business mailing address

22267 SW 97TH CT
CUTLER BAY FL
33190-1535
US

V. Phone/Fax

Practice location:
  • Phone: 786-326-2411
  • Fax:
Mailing address:
  • Phone: 786-326-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11036858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: