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General NPI Number Information
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NPI Number | 1932406402
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Entity Type | Organization
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Legal Business Name | FREDERICK R. YTURRALDE, M.D., P.A.
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/22/2013
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Provider Practice Location Address
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Address Line | 1921 WALDEMERE STREET SUITE 301
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City | SARASOTA
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State | FL
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Zip | 34239-2941
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Country | US
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Telephone | 941-357-1673
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Fax | 800-917-7136
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Provider Business Mailing Address
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Address Line | PO BOX 15529
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City | SARASOTA
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State | FL
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Zip | 34277-1529
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Country | US
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Telephone | 941-357-1673
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Fax | 800-917-7136
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Authorized Official
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Title or Position | OWNER
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Name | DR. FREDERICK R. YTURRALDE
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Credential | MD
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Telephone | 941-357-1673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 98861
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License Number State | FL
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