Healthcare Provider Details

I. General information

NPI: 1568497352
Provider Name (Legal Business Name): YOLAINE MARIE CHAMBLIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 MIRAMAR PKWY SUITE 110
MIRAMAR FL
33025-4100
US

IV. Provider business mailing address

6785 BROOKLINE DR
HIALEAH FL
33015-2441
US

V. Phone/Fax

Practice location:
  • Phone: 954-442-6988
  • Fax: 954-442-6202
Mailing address:
  • Phone: 305-200-1552
  • Fax: 305-200-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME 88893
License Number StateFL

VIII. Authorized Official

Name: DR. YOLAINE MARIE CHAMBLIN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 305-200-1552