1326240565 NPI number — DR. AMARIE M NEGRON-RODRIGUEZ

Table of content: DR. AMARIE M NEGRON-RODRIGUEZ (NPI 1326240565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326240565 NPI number — DR. AMARIE M NEGRON-RODRIGUEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEGRON-RODRIGUEZ
Provider First Name:
AMARIE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1326240565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 W CYPRESS CREEK RD
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-1715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-229-7030
Provider Business Mailing Address Fax Number:
954-229-0963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 W CYPRESS CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-229-7030
Provider Business Practice Location Address Fax Number:
954-229-0963
Provider Enumeration Date:
06/01/2007

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: 207RR0500X , with the licence number:  113392 , 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: 110222900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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