Provider Demographics
NPI:1972012870
Name:PALENZUELA-RODRIGUEZ, YANDY (PA)
Entity Type:Individual
Prefix:MR
First Name:YANDY
Middle Name:
Last Name:PALENZUELA-RODRIGUEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:YANDY
Other - Middle Name:
Other - Last Name:PALENZUELARODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9675 NW 19TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3604
Mailing Address - Country:US
Mailing Address - Phone:561-572-5513
Mailing Address - Fax:
Practice Address - Street 1:4800 NE 20TH TER STE 115
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-776-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant