Healthcare Provider Details

I. General information

NPI: 1326592056
Provider Name (Legal Business Name): YOKASTA URENA M.S.E.D, TVI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13840 68TH DR
FLUSHING NY
11367-1633
US

IV. Provider business mailing address

13840 68TH DR
FLUSHING NY
11367-1633
US

V. Phone/Fax

Practice location:
  • Phone: 646-509-0235
  • Fax:
Mailing address:
  • Phone: 646-509-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number882502141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: