=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093256422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GISCARD HUMBERTO YANEZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2017
-----------------------------------------------------
Last Update Date | 03/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13408 SW 14TH LN
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-710-8008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13408 SW 14TH LN
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-710-8008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246QM0706X
-----------------------------------------------------
Taxonomy Name | Medical Technologist
-----------------------------------------------------
License Number | TN39196
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------