=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396392767
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YURELSY GALVEZ RICARDO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2019
-----------------------------------------------------
Last Update Date | 08/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 MIDDLE BRANCH WAY
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32259-6201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-773-3129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 MIDDLE BRANCH WAY
-----------------------------------------------------
City | SAINT JOHNS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32259-6201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-773-3129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 21505
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------