Provider Demographics
NPI:1881892420
Name:DELGADO-SPASIC, YARA (MD,)
Entity type:Individual
Prefix:
First Name:YARA
Middle Name:
Last Name:DELGADO-SPASIC
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1722
Mailing Address - Country:US
Mailing Address - Phone:954-258-8184
Mailing Address - Fax:877-261-9431
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 317
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-302-9078
Practice Address - Fax:877-261-9431
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99385207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05558OtherBC BS OF FL
FL280762900Medicaid
FL05558OtherBC BS OF FL