Healthcare Provider Details

I. General information

NPI: 1205265667
Provider Name (Legal Business Name): EVELIA F IGLESIAS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5038 CORONADO PKWY
NAPLES FL
34116-6950
US

IV. Provider business mailing address

5038 CORONADO PKWY
NAPLES FL
34116-6950
US

V. Phone/Fax

Practice location:
  • Phone: 239-234-6835
  • Fax: 954-239-3902
Mailing address:
  • Phone: 239-234-6835
  • Fax: 954-239-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME115442
License Number StateFL

VIII. Authorized Official

Name: EVELIA F IGLESIAS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 239-234-6835