1609876804 NPI number — ANABELLE MALDONADO-MEDINA MD

Table of content: ANABELLE MALDONADO-MEDINA MD (NPI 1609876804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609876804 NPI number — ANABELLE MALDONADO-MEDINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALDONADO-MEDINA
Provider First Name:
ANABELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALDONADO
Provider Other First Name:
ANABELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609876804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1190 NW 95 STREET
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33150-2064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-836-5053
Provider Business Mailing Address Fax Number:
305-836-9727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1190 NW 95 STREET
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33150-2064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-836-5053
Provider Business Practice Location Address Fax Number:
305-836-9727
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  ME 0049821 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12606 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4076902 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650123120 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003580 . This is a "NHP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 014296 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 04348 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N1997 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 130009510 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 228896 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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