Provider Demographics
NPI:1760078562
Name:DURAN LOPEZ, YAMILEY I
Entity Type:Individual
Prefix:
First Name:YAMILEY
Middle Name:
Last Name:DURAN LOPEZ
Suffix:I
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 1:6751 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1811
Mailing Address - Country:US
Mailing Address - Phone:786-212-5007
Mailing Address - Fax:
Practice Address - Street 1:6751 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1811
Practice Address - Country:US
Practice Address - Phone:786-212-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF09201484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner