Healthcare Provider Details

I. General information

NPI: 1487469359
Provider Name (Legal Business Name): YELANI LOPEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 SW 87TH AVE
MIAMI FL
33176-2303
US

IV. Provider business mailing address

900 SW 84TH AVE
MIAMI FL
33144-4184
US

V. Phone/Fax

Practice location:
  • Phone: 305-554-7679
  • Fax: 305-554-7616
Mailing address:
  • Phone: 786-349-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9119798
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: