Provider Demographics
NPI:1104223874
Name:RONQUILLO, YASMYNE (MD)
Entity type:Individual
Prefix:
First Name:YASMYNE
Middle Name:
Last Name:RONQUILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YASMYNE
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1180 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3190
Mailing Address - Country:US
Mailing Address - Phone:734-243-5300
Mailing Address - Fax:734-243-3236
Practice Address - Street 1:1180 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3190
Practice Address - Country:US
Practice Address - Phone:734-243-5300
Practice Address - Fax:734-243-3236
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology