Healthcare Provider Details

I. General information

NPI: 1598122558
Provider Name (Legal Business Name): MDNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 NW 122ND ST
HIALEAH GARDENS FL
33018-1748
US

IV. Provider business mailing address

16585 SW 44TH LN
MIAMI FL
33185-3897
US

V. Phone/Fax

Practice location:
  • Phone: 305-351-7181
  • Fax: 305-424-5580
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ENRIQUE MASPONS
Title or Position: PRESIDENT
Credential: ARNP
Phone: 305-456-1153