Provider Demographics
NPI:1528199411
Name:LACLAUSTRA, YVETTE (MD)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:LACLAUSTRA
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3319 STATE ROAD 7
Practice Address - Street 2:SUITE 105
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8094
Practice Address - Country:US
Practice Address - Phone:561-965-1100
Practice Address - Fax:561-965-4143
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 52092174400000X
FLME52092208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1233155OtherWELLCARE
FL1025674OtherCAREPLUS
FL05805OtherBCBS
FL214704OtherAVMED
FL6676OtherDIMENSION HEALTH
FLP969118OtherOPTIMUM
FLP1032787OtherFREEDOM
FL6676OtherDIMENSION HEALTH
FLP969118OtherOPTIMUM