Provider Demographics
NPI:1700108677
Name:YANCE, LUIS A
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:A
Last Name:YANCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 W 84TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4918
Mailing Address - Country:US
Mailing Address - Phone:305-764-3755
Mailing Address - Fax:305-764-3756
Practice Address - Street 1:3412 W 84TH ST STE 102
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4918
Practice Address - Country:US
Practice Address - Phone:305-764-3755
Practice Address - Fax:305-764-3756
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty