Provider Demographics
NPI:1083073571
Name:YERA-VALLE, YORDANYS (MD)
Entity Type:Individual
Prefix:
First Name:YORDANYS
Middle Name:
Last Name:YERA-VALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 IRLO DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2146
Mailing Address - Country:US
Mailing Address - Phone:786-405-5086
Mailing Address - Fax:
Practice Address - Street 1:12301 LAKE UNDERHILL RD STE 223
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4512
Practice Address - Country:US
Practice Address - Phone:689-248-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
FLACN1430208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant