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General NPI Number Information
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NPI Number | 1114699907
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Entity Type | Individual
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Provider Name | JORGE ALBERTO URDANETA AQUI LM
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Gender | Male
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 10540 NW 26TH ST STE G108
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City | DORAL
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State | FL
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Zip | 33172-2162
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Country | US
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Telephone | 786-340-5895
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Fax | 813-365-3074
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Provider Business Mailing Address
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Address Line | 3574 W 94TH ST
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City | HIALEAH
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State | FL
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Zip | 33018-2076
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Country | US
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Telephone | 786-340-5895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MW410
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License Number State | FL
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