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General NPI Number Information
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NPI Number | 1528588878
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Entity Type | Organization
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Legal Business Name | YANTRA PSYCHIATRIC SERVICES, INC.
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 6700 S FLORIDA AVE STE 33
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City | LAKELAND
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State | FL
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Zip | 33813-3312
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Country | US
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Telephone | 863-450-3067
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Fax | 863-337-4123
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Provider Business Mailing Address
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Address Line | 6700 S FLORIDA AVE STE 33
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City | LAKELAND
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State | FL
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Zip | 33813-3312
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Country | US
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Telephone | 863-450-3067
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ROSA E NEGRON-MUNOZ
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Credential | MD
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Telephone | 863-450-3067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME111271
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License Number State | FL
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