Provider Demographics
NPI:1710007950
Name:YAMBAO, RODOLFO M (PA)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:M
Last Name:YAMBAO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 SW 74TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5165
Mailing Address - Country:US
Mailing Address - Phone:305-665-4614
Mailing Address - Fax:305-667-0239
Practice Address - Street 1:9915 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2352
Practice Address - Country:US
Practice Address - Phone:305-665-4614
Practice Address - Fax:305-667-0239
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100002207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ07787Medicare UPIN