Healthcare Provider Details

I. General information

NPI: 1194830109
Provider Name (Legal Business Name): YIRA DE LA PAZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N HIATUS RD STE 103
PEMBROKE PINES FL
33026-5213
US

IV. Provider business mailing address

PO BOX 820897
SOUTH FLORIDA FL
33082-0897
US

V. Phone/Fax

Practice location:
  • Phone: 954-443-4423
  • Fax: 954-443-4483
Mailing address:
  • Phone: 954-443-4423
  • Fax: 954-443-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME89466
License Number StateFL

VIII. Authorized Official

Name: YIRA L DE LA PAZ,
Title or Position: PRESIDENT
Credential: MD
Phone: 954-443-4423