MEDICARE: JENNIFER MBIANDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	ME148916	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295239275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MBIANDA

Provider Business Mailing Address
First Line	:	2213 FUNSTON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5950
Country	:	US
Telephone Number	:	786-559-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 S 21ST AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5015
Country	:	US
Telephone Number	:	781-292-0250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	09/11/2024

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Directions to “ JENNIFER MBIANDA ” Practice Location

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