=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023347291
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICENTE YANEZ SR. SW 4132
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2009
-----------------------------------------------------
Last Update Date | 12/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 814 PONCE DE LEON BLVD SUITE # 418
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-469-1648
-----------------------------------------------------
Fax | 305-442-1018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 PONCE DE LEON BLVD SUITE # 418
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-469-1648
-----------------------------------------------------
Fax | 305-442-1018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW 4132
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------