Healthcare Provider Details

I. General information

NPI: 1205020450
Provider Name (Legal Business Name): LOUISE A DEPODESTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 NE 2ND AVE SEASONS HOSPICE & PALLIATIVE CARE
MIAMI FL
33137-2706
US

IV. Provider business mailing address

5200 NE 2ND AVE SEASONS HOSPICE & PALLIATIVE CARE
MIAMI FL
33137-2706
US

V. Phone/Fax

Practice location:
  • Phone: 305-762-0637
  • Fax:
Mailing address:
  • Phone: 305-762-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085H0002X
TaxonomyHospice and Palliative Medicine (Radiology) Physician
License Number233623
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberME 129681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: