Provider Demographics
NPI:1376366211
Name:YATES, BOBETH N
Entity type:Individual
Prefix:
First Name:BOBETH
Middle Name:N
Last Name:YATES
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 1:18800 NW 2ND AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4064
Mailing Address - Country:US
Mailing Address - Phone:305-653-4755
Mailing Address - Fax:305-653-8520
Practice Address - Street 1:18800 NW 2ND AVE STE 122
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4064
Practice Address - Country:US
Practice Address - Phone:305-653-4755
Practice Address - Fax:305-653-8520
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor