Provider Demographics
NPI:1871534313
Name:MENDEZ CABAN, YAMILETTE (MD)
Entity type:Individual
Prefix:DR
First Name:YAMILETTE
Middle Name:
Last Name:MENDEZ CABAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 FORTUNE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4428
Mailing Address - Country:US
Mailing Address - Phone:407-943-8600
Mailing Address - Fax:
Practice Address - Street 1:1507 BILL BECK BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-9516
Practice Address - Country:US
Practice Address - Phone:407-943-8600
Practice Address - Fax:407-932-5140
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14147208D00000X
FLACN1177208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103962900Medicaid