Healthcare Provider Details

I. General information

NPI: 1780077032
Provider Name (Legal Business Name): JOSE I. PRADERE, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NW 57TH AVE STE 110
MIAMI FL
33126-2041
US

IV. Provider business mailing address

815 NW 57TH AVE STE 110
MIAMI FL
33126-2041
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-6371
  • Fax: 305-262-2545
Mailing address:
  • Phone: 305-856-6371
  • Fax: 305-262-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME28209
License Number StateFL

VIII. Authorized Official

Name: DIANA K. ARAUZ
Title or Position: MANAGER
Credential:
Phone: 305-856-6371