Provider Demographics
NPI:1689922122
Name:YGLESIAS, KRISTY
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:YGLESIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21700 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 875
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4906
Mailing Address - Country:US
Mailing Address - Phone:313-389-4900
Mailing Address - Fax:313-389-8685
Practice Address - Street 1:21700 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 875
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4906
Practice Address - Country:US
Practice Address - Phone:313-389-4900
Practice Address - Fax:313-389-8685
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1564343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)