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General NPI Number Information
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NPI Number | 1205095544
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Entity Type | Organization
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Legal Business Name | FEDORA ELIPE
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 7547 W 24TH AVE SUITE 200
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City | HIALEAH
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State | FL
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Zip | 33016-6515
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Country | US
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Telephone | 305-556-1875
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Fax | 866-475-1809
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Provider Business Mailing Address
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Address Line | 7547 W 24TH AVE SUITE 200
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City | HIALEAH
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State | FL
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Zip | 33016-6515
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Country | US
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Telephone | 305-556-1875
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Fax | 866-475-1809
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Authorized Official
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Title or Position | REGISTERED NURSE/MANAGER
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Name | MS. FEDORA ELIPE
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Credential | RN
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Telephone | 305-556-1875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | RN9238359
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License Number State | FL
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