Provider Demographics
NPI:1215310396
Name:DUARTE, YALIXIS
Entity type:Individual
Prefix:
First Name:YALIXIS
Middle Name:
Last Name:DUARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 N CRYSTAL LAKE DR APT 43
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6587
Mailing Address - Country:US
Mailing Address - Phone:786-262-4584
Mailing Address - Fax:863-608-7602
Practice Address - Street 1:1836 N CRYSTAL LAKE DR APT 43
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6587
Practice Address - Country:US
Practice Address - Phone:786-262-4584
Practice Address - Fax:863-608-7602
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015229900Medicaid