1831260587 NPI number — MRS. MARIA CRUZ FANDETTI RPH

Table of content: MRS. MARIA CRUZ FANDETTI RPH (NPI 1831260587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831260587 NPI number — MRS. MARIA CRUZ FANDETTI RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FANDETTI
Provider First Name:
MARIA
Provider Middle Name:
CRUZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FANDETTI
Provider Other First Name:
MARIA
Provider Other Middle Name:
ESTHER
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831260587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2436 GLASCOTT PT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35226-6320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-941-9905
Provider Business Mailing Address Fax Number:
954-457-7164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 E HALLANDALE BCH BLVD
Provider Second Line Business Practice Location Address:
BVD GET DRUGS
Provider Business Practice Location Address City Name:
HALLANDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-457-8011
Provider Business Practice Location Address Fax Number:
954-457-7164
Provider Enumeration Date:
11/13/2006

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: 183500000X , with the licence number:  PS18763 , 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)