Healthcare Provider Details

I. General information

NPI: 1609876804
Provider Name (Legal Business Name): ANABELLE MALDONADO-MEDINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANABELLE MALDONADO MD

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 NW 95 STREET SUITE 204
MIAMI FL
33150-2064
US

IV. Provider business mailing address

1190 NW 95 STREET SUITE 204
MIAMI FL
33150-2064
US

V. Phone/Fax

Practice location:
  • Phone: 305-836-5053
  • Fax: 305-836-9727
Mailing address:
  • Phone: 305-836-5053
  • Fax: 305-836-9727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME 0049821
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: