=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205359577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA MONSERRAT NUNEZ STIGLICH PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2017
-----------------------------------------------------
Last Update Date | 10/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11760 BIRD RD STE 539
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-8100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-228-6200
-----------------------------------------------------
Fax | 305-228-1314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 191 CRYSTAL LAKE RD
-----------------------------------------------------
City | ENFIELD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03748-3741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-276-0003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | PA9112388
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------