Provider Demographics
NPI:1528588878
Name:YANTRA PSYCHIATRIC SERVICES, INC.
Entity Type:Organization
Organization Name:YANTRA PSYCHIATRIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEGRON-MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-450-3067
Mailing Address - Street 1:6700 S FLORIDA AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3312
Mailing Address - Country:US
Mailing Address - Phone:863-450-3067
Mailing Address - Fax:
Practice Address - Street 1:6700 S FLORIDA AVE STE 33
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3312
Practice Address - Country:US
Practice Address - Phone:863-450-3067
Practice Address - Fax:863-337-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1112712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003962200Medicaid
FL022279400Medicaid