Provider Demographics
NPI:1043247604
Name:BURGOS, YOLANDA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:M
Last Name:BURGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 HARDING AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141
Mailing Address - Country:US
Mailing Address - Phone:305-865-4550
Mailing Address - Fax:305-865-4064
Practice Address - Street 1:7109 HARDING AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3213
Practice Address - Country:US
Practice Address - Phone:305-865-4550
Practice Address - Fax:305-865-4064
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27860Medicare UPIN
FL95317AMedicare ID - Type UnspecifiedMEDICARE PROVIDER