Provider Demographics
NPI:1669280053
Name:GUEVARA PORTELL, YAMILE DE LOS ANGELES
Entity type:Individual
Prefix:
First Name:YAMILE
Middle Name:DE LOS ANGELES
Last Name:GUEVARA PORTELL
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 1:22267 SW 97TH CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1535
Mailing Address - Country:US
Mailing Address - Phone:786-326-2411
Mailing Address - Fax:
Practice Address - Street 1:22267 SW 97TH CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1535
Practice Address - Country:US
Practice Address - Phone:786-326-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036858363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner