Provider Demographics
NPI:1457936775
Name:RICARDO PALOMARES, YESENIA (PTA)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:RICARDO PALOMARES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SW 8TH ST APT W1009
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3570
Mailing Address - Country:US
Mailing Address - Phone:305-785-4611
Mailing Address - Fax:
Practice Address - Street 1:1890 SW 57TH AVE STE 111
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2164
Practice Address - Country:US
Practice Address - Phone:305-262-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30459225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty