Individual
YVETTE LACLAUSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3319 STATE ROAD 7, SUITE 105, WELLINGTON, FL 33449-8094
(561) 965-1100
(561) 965-4143
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME 52092
FL
208600000X
Surgery Physician
Primary
ME52092
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05805
BCBS
FL
01
—
1025674
CAREPLUS
FL
01
—
1233155
WELLCARE
FL
01
—
214704
AVMED
FL
01
—
6676
DIMENSION HEALTH
FL
01
—
P1032787
FREEDOM
FL
01
—
P969118
OPTIMUM
FL
Enumeration date
03/09/2007
Last updated
10/13/2016
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