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NPI Code Detail

MEDICARE: LYDIA PUENTE PA

MEDICARE: LYDIA PUENTE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianME80396FL

General Provider Information

NPI Number : 1194115642
Entity Type Code : Organization
Provider Name (Legal Business Name) : LYDIA PUENTE PA
Provider Business Mailing Address
First Line : 2645 SW 37TH AVE STE 101
Second Line :
City : MIAMI
State : FL
Zip : 33133-2744
Country : US
Telephone Number : 305-447-2317
Fax Number : 305-447-2292
Provider Business Practice Location Address
First Line : 2645 SW 37TH AVE STE 101
Second Line :
City : MIAMI
State : FL
Zip : 33133-2744
Country : US
Telephone Number : 305-447-2317
Fax Number : 305-447-2292
Authorized Official
Title or Position : PRESIDENT
Name : DR. LYDIA PUENTE
Credential : MD
Telephone Number : 305-447-2317
Provider Enumeration Date : 02/04/2015
Last Update Date : 02/04/2015

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Directions to “LYDIA PUENTE PA ” Practice Location

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