Provider Demographics
NPI:1437110236
Name:YCAZA, ROBERTO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:J
Last Name:YCAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1640
Mailing Address - Country:US
Mailing Address - Phone:941-803-8395
Mailing Address - Fax:941-803-8158
Practice Address - Street 1:2105 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1640
Practice Address - Country:US
Practice Address - Phone:941-803-8395
Practice Address - Fax:941-803-8158
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66839208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271586400Medicaid
FL201862196OtherTAX IDENTIFICATION
FL271586400Medicaid