Provider Demographics
NPI:1629521489
Name:YAKSIC GROUP LLC
Entity Type:Organization
Organization Name:YAKSIC GROUP LLC
Other - Org Name:NOBEL MEDICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:YAKSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-330-5009
Mailing Address - Street 1:1900 CORAL WAY
Mailing Address - Street 2:STE 202
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2661
Mailing Address - Country:US
Mailing Address - Phone:305-330-5009
Mailing Address - Fax:844-860-0611
Practice Address - Street 1:12856 SW 211TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7439
Practice Address - Country:US
Practice Address - Phone:305-330-5009
Practice Address - Fax:844-860-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL16000115325OtherDOCUMENT NUMBER