Provider Demographics
NPI:1780977033
Name:VINA, YOANSY (MA)
Entity type:Individual
Prefix:MR
First Name:YOANSY
Middle Name:
Last Name:VINA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 SW 121ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3124
Mailing Address - Country:US
Mailing Address - Phone:786-326-5448
Mailing Address - Fax:315-326-0504
Practice Address - Street 1:3620 SW 121ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3124
Practice Address - Country:US
Practice Address - Phone:786-326-5448
Practice Address - Fax:315-326-0504
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63123261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA63123OtherMASSAGE THERAPIST