Healthcare Provider Details

I. General information

NPI: 1265017842
Provider Name (Legal Business Name): YASNNY ROSARIO SALTARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 13TH ST
SAINT CLOUD FL
34769-6763
US

IV. Provider business mailing address

2643 WILLOW GLEN CIR
KISSIMMEE FL
34744-5478
US

V. Phone/Fax

Practice location:
  • Phone: 407-957-4333
  • Fax:
Mailing address:
  • Phone: 787-508-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSI42451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: