MEDICARE: JOSE YOANDRY ALF

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	310400000X	Assisted Living Facility	AL11443	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568765709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE YOANDRY ALF

Provider Business Mailing Address
First Line	:	2916 NW 31ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5844
Country	:	US
Telephone Number	:	305-635-9881
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 NW 31ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5844
Country	:	US
Telephone Number	:	305-635-9881
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JOSE PENA
Credential	:
Telephone Number	:	786-303-8859

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	12/09/2010

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