Healthcare Provider Details

I. General information

NPI: 1033994009
Provider Name (Legal Business Name): RUDRINE ANGEL ALEXIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

2751 NW 38TH TER
LAUDERDALE LAKES FL
33311-1856
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-1960
  • Fax:
Mailing address:
  • Phone: 954-662-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: