MEDICARE: YORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1508665563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YORT LLC

Provider Business Mailing Address
First Line	:	2405 W PIERCE ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-3513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 W PIERCE ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-3513
Country	:	US
Telephone Number	:	575-243-8084
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	JAYCE RODRIGUEZ
Credential	:	PA-C
Telephone Number	:	575-243-8084

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	04/01/2025

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Directions to “YORT LLC ” Practice Location

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