Provider Demographics
NPI:1194830109
Name:YIRA DE LA PAZ MD PA
Entity Type:Organization
Organization Name:YIRA DE LA PAZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YIRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE LA PAZ,
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-443-4423
Mailing Address - Street 1:PO BOX 820897
Mailing Address - Street 2:
Mailing Address - City:SOUTH FLORIDA
Mailing Address - State:FL
Mailing Address - Zip Code:33082-0897
Mailing Address - Country:US
Mailing Address - Phone:954-443-4423
Mailing Address - Fax:954-443-4483
Practice Address - Street 1:500 N HIATUS RD
Practice Address - Street 2:STE 103
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5213
Practice Address - Country:US
Practice Address - Phone:954-443-4423
Practice Address - Fax:954-443-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50017OtherBCBS OF FL
FL50017OtherBCBS OF FL
I15686Medicare UPIN
FL50017OtherBCBS OF FL
FLAB415Medicare PIN