1841389327 NPI number — EFERILDIA STELLA GERSON ARNP

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 1841389327 NPI number — EFERILDIA STELLA GERSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERSON
Provider First Name:
EFERILDIA
Provider Middle Name:
STELLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAEZ
Provider Other First Name:
EFERILDIA
Provider Other Middle Name:
STELLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841389327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11440 SW 88TH ST
Provider Second Line Business Mailing Address:
STE. 109
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-1044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-263-0001
Provider Business Mailing Address Fax Number:
786-263-0004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11440 SW 88TH ST
Provider Second Line Business Practice Location Address:
STE. 109
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-263-0001
Provider Business Practice Location Address Fax Number:
786-263-0004
Provider Enumeration Date:
10/12/2006

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: 363L00000X , with the licence number:  ARNP2047952 , 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: 0345865 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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