Healthcare Provider Details

I. General information

NPI: 1710656863
Provider Name (Legal Business Name): MELANIE YEPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2021
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9621 SW 163RD AVE
MIAMI FL
33196-5830
US

IV. Provider business mailing address

9621 SW 163RD AVE
MIAMI FL
33196-5830
US

V. Phone/Fax

Practice location:
  • Phone: 305-484-1007
  • Fax:
Mailing address:
  • Phone: 305-484-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010886
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPRN11010886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: