MEDICARE: Y LINE 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	174400000X	Specialist

General Provider Information

NPI Number	:	1568852101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Y LINE LLC

Provider Business Mailing Address
First Line	:	3325 GRIFFIN RD STE 185
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5500
Country	:	US
Telephone Number	:	305-772-7418
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 GRIFFIN RD STE 185
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5500
Country	:	US
Telephone Number	:	305-772-7418
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RICARDO GARCIA
Credential	:
Telephone Number	:	305-772-7418

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	02/04/2015

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Directions to “Y LINE LLC ” Practice Location

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