Provider Demographics
NPI:1669490041
Name:YANES, CHARLES FERNANDO (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FERNANDO
Last Name:YANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1533 SUNSET DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5773
Mailing Address - Country:US
Mailing Address - Phone:305-668-9678
Mailing Address - Fax:305-663-7992
Practice Address - Street 1:1533 SUNSET DR STE 200
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-5773
Practice Address - Country:US
Practice Address - Phone:305-668-9678
Practice Address - Fax:305-663-7992
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300512700Medicaid
FLG69913Medicare UPIN
FLE0709BMedicare PIN