Provider Demographics
NPI:1346663879
Name:YANIQUE DUVAL MD PA
Entity Type:Organization
Organization Name:YANIQUE DUVAL MD PA
Other - Org Name:DUVAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDELYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZEFORT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-687-1304
Mailing Address - Street 1:2247 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE # 108
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3470
Mailing Address - Country:US
Mailing Address - Phone:561-687-1304
Mailing Address - Fax:561-687-1306
Practice Address - Street 1:518 SW PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:561-687-1304
Practice Address - Fax:561-687-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1956AD813301261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder