MEDICARE: DAIYANA MALDONADO PEREZ

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	363LA2200X	Adult Health Nurse Practitioner	9339423	FL
2	363LG0600X	Gerontology Nurse Practitioner	9339423	FL

General Provider Information

NPI Number	:	1699222448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAIYANA MALDONADO PEREZ

Provider Business Mailing Address
First Line	:	3503 SW 150TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-3969
Country	:	US
Telephone Number	:	786-291-4571
Fax Number	:

Provider Business Practice Location Address
First Line	:	3503 SW 150TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-3969
Country	:	US
Telephone Number	:	786-291-4571
Fax Number	:

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

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	09/08/2016

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Directions to “ DAIYANA MALDONADO PEREZ ” Practice Location

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