Provider Demographics
NPI:1750702189
Name:PINEIRO PUEBLA, YANELY (MD)
Entity type:Individual
Prefix:
First Name:YANELY
Middle Name:
Last Name:PINEIRO PUEBLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 TAFT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4384
Mailing Address - Country:US
Mailing Address - Phone:954-487-1516
Mailing Address - Fax:954-487-1519
Practice Address - Street 1:12311 TAFT ST STE 1
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4384
Practice Address - Country:US
Practice Address - Phone:954-487-1516
Practice Address - Fax:954-487-1519
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 119291207R00000X
FLME119291208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016072800Medicaid