Healthcare Provider Details

I. General information

NPI: 1528057882
Provider Name (Legal Business Name): GINA CUADRADO-VENDETTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21150 BISCAYNE BLVD AVENTURA
AVENTURA FL
33180-1226
US

IV. Provider business mailing address

21150 BISCAYNE BLVD AVENTURA
AVENTURA FL
33180-1226
US

V. Phone/Fax

Practice location:
  • Phone: 305-466-9988
  • Fax:
Mailing address:
  • Phone: 305-466-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME91051
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME91051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: