Provider Demographics
NPI:1932406402
Name:FREDERICK R. YTURRALDE, M.D., P.A.
Entity Type:Organization
Organization Name:FREDERICK R. YTURRALDE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:YTURRALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-357-1673
Mailing Address - Street 1:PO BOX 15529
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-1529
Mailing Address - Country:US
Mailing Address - Phone:941-357-1673
Mailing Address - Fax:800-917-7136
Practice Address - Street 1:1921 WALDEMERE STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2941
Practice Address - Country:US
Practice Address - Phone:941-357-1673
Practice Address - Fax:800-917-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL98861174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty