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General NPI Number Information
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NPI Number | 1912638545
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Entity Type | Organization
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Legal Business Name | MARIA MEDEROS APRN PA
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 2097 W 76TH ST
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City | HIALEAH
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State | FL
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Zip | 33016-1834
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Country | US
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Telephone | 786-925-0580
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 MAIN ST APT 1414
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2291
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Country | US
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Telephone | 305-333-2975
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. MARIA ANGELES MEDEROS
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Credential | APRN
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Telephone | 305-333-2975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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