=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689437634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YESHUA MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2024
-----------------------------------------------------
Last Update Date | 06/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13255 SW 137TH AVE STE 109
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-5327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-877-1646
-----------------------------------------------------
Fax | 786-250-4129
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13255 SW 137TH AVE STE 109
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-5327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-250-4145
-----------------------------------------------------
Fax | 786-250-4129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | YANET PEREZ PRIETO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-877-1646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------