1487756722 NPI number — MRS. ELDA PILAR LAUDERMAN REGALADO MD

Table of content: MRS. ELDA PILAR LAUDERMAN REGALADO MD (NPI 1487756722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487756722 NPI number — MRS. ELDA PILAR LAUDERMAN REGALADO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAUDERMAN REGALADO
Provider First Name:
ELDA
Provider Middle Name:
PILAR
Provider Name Prefix Text:
MRS.
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:
REGALADO
Provider Other First Name:
ELDA
Provider Other Middle Name:
PILAR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487756722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14441 SW 37TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33027-3787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-430-4167
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15600 NW 67TH AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33014-2175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-760-2525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2006

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: 207R00000X , with the licence number:  ME0065129 , 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: 374529500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114221300 . 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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