Healthcare Provider Details

I. General information

NPI: 1801880448
Provider Name (Legal Business Name): MARIA ELOISA DEPADUA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAGNOLIA AVE SW
WINTER HAVEN FL
33880-2943
US

IV. Provider business mailing address

950 COUNTY ROAD 17A W
AVON PARK FL
33825-2164
US

V. Phone/Fax

Practice location:
  • Phone: 866-234-8534
  • Fax: 863-229-7999
Mailing address:
  • Phone: 863-452-3060
  • Fax: 863-452-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME68809
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: