Provider Demographics
NPI:1396176061
Name:YANIUE DUVAL MD PA
Entity type:Organization
Organization Name:YANIUE DUVAL MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDELYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZEFORT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-687-1304
Mailing Address - Street 1:2247 PALM BEACH LAKES BLVD
Mailing Address - Street 2:108
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3470
Mailing Address - Country:US
Mailing Address - Phone:561-687-1430
Mailing Address - Fax:561-687-1306
Practice Address - Street 1:2247 PALM BEACH LAKES BLVD
Practice Address - Street 2:108
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3470
Practice Address - Country:US
Practice Address - Phone:561-687-1304
Practice Address - Fax:561-687-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1550AD813301261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273843100Medicaid
FLAA030Medicare PIN
FLI66370Medicare UPIN