Provider Demographics
NPI:1568930923
Name:RODRIGUEZ PORTAL, YULEXIS (MT)
Entity Type:Individual
Prefix:MRS
First Name:YULEXIS
Middle Name:
Last Name:RODRIGUEZ PORTAL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7175 SW 8TH ST STE 213-214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4676
Mailing Address - Country:US
Mailing Address - Phone:305-456-6055
Mailing Address - Fax:786-431-3126
Practice Address - Street 1:7175 SW 8TH ST STE 213-214
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4676
Practice Address - Country:US
Practice Address - Phone:305-456-6055
Practice Address - Fax:786-431-3126
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA85515225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA85515OtherMESAGE THERAPIST