Provider Demographics
NPI:1225070584
Name:DE LA PAZ, YIRA LARISSA (MD)
Entity Type:Individual
Prefix:
First Name:YIRA
Middle Name:LARISSA
Last Name:DE LA PAZ
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 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:4850 W OAKLAND PARK BLVD STE 148
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7277
Practice Address - Country:US
Practice Address - Phone:954-735-1200
Practice Address - Fax:954-731-8408
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89466208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270655500Medicaid
FLKP510OtherMEDICARE
FL7350555OtherAETNA
FL270655500Medicaid
FL50017OtherBLUE SHIELD
FL40916BOtherBLUE CROSS
FLBD8481169OtherDEA
FL270655500Medicaid
FL7350555OtherAETNA