Provider Demographics
NPI:1336908409
Name:MOUSTARIH SAKKAL, YAKELIN DIVA
Entity Type:Individual
Prefix:
First Name:YAKELIN
Middle Name:DIVA
Last Name:MOUSTARIH SAKKAL
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 1:21075 NE 34TH AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3540
Mailing Address - Country:US
Mailing Address - Phone:786-617-6326
Mailing Address - Fax:
Practice Address - Street 1:21075 NE 34TH AVE APT 404
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3540
Practice Address - Country:US
Practice Address - Phone:786-617-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDRPM2712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program