Healthcare Provider Details

I. General information

NPI: 1013358001
Provider Name (Legal Business Name): DR. YAHYA E D A R ALANSARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

11520 SW 29TH ST APARTMENT 106
MIRAMAR FL
33025-7862
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5215
  • Fax: 305-585-8137
Mailing address:
  • Phone: 954-812-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN18362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: