=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750694493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEATRIZ E AMENDOLA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2010
-----------------------------------------------------
Last Update Date | 03/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5995 SW 71ST ST #1A
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-598-0811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5995 SW 71ST ST #1A
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-598-0811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BEATRIZ E AMENDOLA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-598-0811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------