1639535016 NPI number — ANA MARIA GARCIA IGUARAN MD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639535016 NPI number — ANA MARIA GARCIA IGUARAN MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANA MARIA GARCIA IGUARAN MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639535016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5068 ANNUNCIATION CIR UNIT 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVE MARIA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34142-9668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-743-6076
Provider Business Mailing Address Fax Number:
786-292-2962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7959 NW 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-743-6076
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA IGUARAN
Authorized Official First Name:
ANA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
PHYSICIAN, PRESIDENT
Authorized Official Telephone Number:
405-317-1258

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  ME123805 , 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: 102572000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".