Provider Demographics
NPI:1033704150
Name:PRIETO CORTINA, YANET
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:PRIETO CORTINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29920 SW 151ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3742
Mailing Address - Country:US
Mailing Address - Phone:786-973-4405
Mailing Address - Fax:
Practice Address - Street 1:29920 SW 151ST AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3742
Practice Address - Country:US
Practice Address - Phone:786-973-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine