Healthcare Provider Details

I. General information

NPI: 1730662586
Provider Name (Legal Business Name): YLLEN YARETH HERNANDEZ BLANCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SANDLAKE COMMONS BLVD STE 127
ORLANDO FL
32819-8011
US

IV. Provider business mailing address

7300 SANDLAKE COMMONS BLVD STE 127
ORLANDO FL
32819-8011
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-4344
  • Fax: 321-842-4784
Mailing address:
  • Phone: 321-841-4344
  • Fax: 321-842-4784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME173992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: