Healthcare Provider Details

I. General information

NPI: 1700945102
Provider Name (Legal Business Name): AIDA DEL RIO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 NW 42ND AVE
MIAMI FL
33126-5435
US

IV. Provider business mailing address

4800 SW 141ST AVE
MIAMI FL
33175-4820
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-0809
  • Fax: 305-448-9123
Mailing address:
  • Phone: 305-554-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 3493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: