Provider Demographics
NPI:1790023158
Name:YD MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:YD MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUENAS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:786-366-1742
Mailing Address - Street 1:13255 SW 137TH AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5328
Mailing Address - Country:US
Mailing Address - Phone:786-366-1742
Mailing Address - Fax:305-397-2406
Practice Address - Street 1:13255 SW 137TH AVE STE 213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5328
Practice Address - Country:US
Practice Address - Phone:786-366-1742
Practice Address - Fax:305-397-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2013FLO25OtherCMERCIAL INSURANCES, HMO,PPO