Provider Demographics
NPI:1336422039
Name:YAQUE, JOSEAN ALBERTO
Entity type:Individual
Prefix:MR
First Name:JOSEAN
Middle Name:ALBERTO
Last Name:YAQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 NW 36 STREET
Mailing Address - Street 2:STE 108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-871-9221
Mailing Address - Fax:305-871-0070
Practice Address - Street 1:6555 NW 36TH ST
Practice Address - Street 2:STE 108
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6978
Practice Address - Country:US
Practice Address - Phone:305-871-9221
Practice Address - Fax:305-871-0070
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist