Basic Information
| Provider Information | |||||||||
| NPI: | 1245897701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEARRIBA | ||||||||
| FirstName: | EDGARDO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9615 SW 24TH ST APT A124 | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331658081 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 363 S HOMESTEAD BLVD | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330307309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552266633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-19-83572 | FL | N | 163W00000X | RN-9364398 | FL | N | Nursing Service Providers | Registered Nurse | 363LP2300X | APRN-11021754 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.