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NPI Code Detail

MEDICARE: ODALYS FRONTELA M.D.

MEDICARE: ODALYS FRONTELA M.D.
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
1207R00000XInternal Medicine PhysicianME0078396FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639102700
Entity Type Code : Individual
Provider Name (Legal Business Name) : ODALYS FRONTELA M.D.
Provider Business Mailing Address
First Line : 801 W 48TH ST STE A
Second Line :
City : HIALEAH
State : FL
Zip : 33012-3541
Country : US
Telephone Number : 305-698-7172
Fax Number : 305-698-7649
Provider Business Practice Location Address
First Line : 801 W 48 STREET SUITE A
Second Line :
City : HIALEAH
State : FL
Zip : 33012-5427
Country : US
Telephone Number : 305-698-7172
Fax Number : 305-698-7649
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2006
Last Update Date : 12/22/2008

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