Provider Demographics
NPI:1780080275
Name:CHARLES, YVROSE (LAC)
Entity type:Individual
Prefix:MRS
First Name:YVROSE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 W OAKLAND PARK BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1215
Mailing Address - Country:US
Mailing Address - Phone:954-654-3638
Mailing Address - Fax:
Practice Address - Street 1:3075 W OAKLAND PARK BOULEVARD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1215
Practice Address - Country:US
Practice Address - Phone:954-654-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3563171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist