Provider Demographics
NPI:1831188259
Name:RIVERA-CAUDILL, YOLANDA M (MD)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:M
Last Name:RIVERA-CAUDILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31140
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33631-3140
Mailing Address - Country:US
Mailing Address - Phone:954-965-7400
Mailing Address - Fax:954-967-6410
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:C-350
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:330-527-1471
Practice Address - Fax:305-271-8732
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME60713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372098500Medicaid
FL372098500Medicaid