Healthcare Provider Details

I. General information

NPI: 1972990810
Provider Name (Legal Business Name): CHARLOTTE TUDELA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 BIRD ROAD KENDALL REGIONALL MEDICAL CENTER
MIAMI FL
33175
US

IV. Provider business mailing address

6200 SW 73RD ST # 69
SOUTH MIAMI FL
33143-4679
US

V. Phone/Fax

Practice location:
  • Phone: 305-480-6663
  • Fax:
Mailing address:
  • Phone: 786-662-5465
  • Fax: 786-662-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME136843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: