Healthcare Provider Details

I. General information

NPI: 1619981461
Provider Name (Legal Business Name): MAEDELY DE ARMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 PALM AVE
HIALEAH FL
33012-5427
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-0590
  • Fax: 305-642-6326
Mailing address:
  • Phone: 305-642-0590
  • Fax: 305-642-6326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND4182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: