Healthcare Provider Details

I. General information

NPI: 1053258749
Provider Name (Legal Business Name): KEVIN HECTOR YUPANQUI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NW 79TH AVE
DORAL FL
33122-1174
US

IV. Provider business mailing address

5203 SW 148TH AVE
MIRAMAR FL
33027-3679
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-1000
  • Fax:
Mailing address:
  • Phone: 305-528-9486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number9490251
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: