Provider Demographics
NPI:1518453299
Name:YLC MIGS-CPP SPECIALIST LLC
Entity Type:Organization
Organization Name:YLC MIGS-CPP SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-307-1100
Mailing Address - Street 1:15 CALLE LUNA
Mailing Address - Street 2:URB ADOQUINES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-293-5386
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON STE 812
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5031
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144584012OtherNPI