Healthcare Provider Details

I. General information

NPI: 1891997904
Provider Name (Legal Business Name): CARMEN TUDELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW 9TH AVE SUITE 201
MIAMI FL
33136-1101
US

IV. Provider business mailing address

7300 SW 117TH TER
MIAMI FL
33156-4668
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-8444
  • Fax:
Mailing address:
  • Phone: 305-321-6242
  • Fax: 214-645-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN6730
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME107600
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: