Provider Demographics
NPI:1558687228
Name:DEL RIO, YANDI
Entity Type:Individual
Prefix:
First Name:YANDI
Middle Name:
Last Name:DEL RIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4742 WEST FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1452
Mailing Address - Country:US
Mailing Address - Phone:305-456-7771
Mailing Address - Fax:305-456-7771
Practice Address - Street 1:4742 WEST FLAGLER ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1452
Practice Address - Country:US
Practice Address - Phone:305-456-7771
Practice Address - Fax:305-456-7771
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist