Provider Demographics
NPI:1518904606
Name:LUIS-ROIG, YANIK (MD)
Entity Type:Individual
Prefix:DR
First Name:YANIK
Middle Name:
Last Name:LUIS-ROIG
Suffix:
Gender:F
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:PO BOX 410005
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-0005
Mailing Address - Country:US
Mailing Address - Phone:321-751-7545
Mailing Address - Fax:321-751-0311
Practice Address - Street 1:1331 BEDFORD DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-751-7545
Practice Address - Fax:321-751-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00627782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26899OtherBCBSFL
FLF95903Medicare UPIN
FL26899WMedicare ID - Type Unspecified