Basic Information
Provider Information | |||||||||
NPI: | 1316190358 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DE ARMENDI | ||||||||
FirstName: | ANGEL | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DE ARMENDI | ||||||||
OtherFirstName: | ANGEL | ||||||||
OtherMiddleName: | A. | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 9725 NW 117TH AVE STE 200 | ||||||||
Address2: |   | ||||||||
City: | MEDLEY | ||||||||
State: | FL | ||||||||
PostalCode: | 331781260 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9544320578 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5190 NW 167TH ST STE 109 | ||||||||
Address2: |   | ||||||||
City: | MIAMI LAKES | ||||||||
State: | FL | ||||||||
PostalCode: | 330146329 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8552266633 | ||||||||
FaxNumber: | 8442242818 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/03/2008 | ||||||||
LastUpdateDate: | 02/04/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/04/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 17369 | PR | N |   | Other Service Providers | Specialist |   | 208D00000X | ACN460 | FL | Y |   | Allopathic & Osteopathic Physicians | General Practice |   |
No ID Information.