Provider Demographics
NPI:1376372979
Name:PALENZUELA BECERRA, YAUDEL ANGEL
Entity type:Individual
Prefix:
First Name:YAUDEL
Middle Name:ANGEL
Last Name:PALENZUELA BECERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 ILEX AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-3018
Mailing Address - Country:US
Mailing Address - Phone:786-712-5958
Mailing Address - Fax:
Practice Address - Street 1:5340 ILEX AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3018
Practice Address - Country:US
Practice Address - Phone:786-712-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4024557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily