Healthcare Provider Details

I. General information

NPI: 1225836042
Provider Name (Legal Business Name): MR. YADIAN IGLESIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N OCEAN BLVD APT 306S
FORT LAUDERDALE FL
33305-3753
US

IV. Provider business mailing address

2001 N OCEAN BLVD APT 306S
FORT LAUDERDALE FL
33305-3753
US

V. Phone/Fax

Practice location:
  • Phone: 305-742-7454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9436323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: