Provider Demographics
NPI:1558069039
Name:VALDES RODRIGUEZ, YAILEN (MA98838)
Entity Type:Individual
Prefix:
First Name:YAILEN
Middle Name:
Last Name:VALDES RODRIGUEZ
Suffix:
Gender:F
Credentials:MA98838
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 W 62ND PL APT 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5922
Mailing Address - Country:US
Mailing Address - Phone:305-879-7032
Mailing Address - Fax:
Practice Address - Street 1:2730 W 62ND PL APT 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5922
Practice Address - Country:US
Practice Address - Phone:305-879-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist