Provider Demographics
NPI:1043580814
Name:RICARDO, YUDELKIS (MA)
Entity Type:Individual
Prefix:MRS
First Name:YUDELKIS
Middle Name:
Last Name:RICARDO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 W FLAGLER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2031
Mailing Address - Country:US
Mailing Address - Phone:305-222-9214
Mailing Address - Fax:305-222-9244
Practice Address - Street 1:8660 W FLAGLER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2031
Practice Address - Country:US
Practice Address - Phone:305-222-9214
Practice Address - Fax:305-222-9244
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 66099225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL453837147OtherMASSAGE THERAPY