Provider Demographics
NPI:1265002471
Name:PEREDA, YATSUNARYS
Entity Type:Individual
Prefix:
First Name:YATSUNARYS
Middle Name:
Last Name:PEREDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 E 4TH AVE # TH
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4853
Mailing Address - Country:US
Mailing Address - Phone:786-444-3741
Mailing Address - Fax:
Practice Address - Street 1:1901 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1601
Practice Address - Country:US
Practice Address - Phone:305-576-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH27425124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist