Provider Demographics
NPI:1306366992
Name:YANELY PINEIRO PUEBLA MD. PA.
Entity Type:Organization
Organization Name:YANELY PINEIRO PUEBLA MD. PA.
Other - Org Name:PRIORITY FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YANELY
Authorized Official - Middle Name:
Authorized Official - Last Name:PINEIRO PUEBLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-720-1191
Mailing Address - Street 1:12311 TAFT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4384
Mailing Address - Country:US
Mailing Address - Phone:954-487-1516
Mailing Address - Fax:954-487-1519
Practice Address - Street 1:12311 TAFT ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4384
Practice Address - Country:US
Practice Address - Phone:305-720-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016072800Medicaid