Basic Information
| Provider Information | |||||||||
| NPI: | 1457780926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADOR | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8940 N KENDALL DR | ||||||||
| Address2: | SUITE 504E | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331762148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055956200 | ||||||||
| FaxNumber: | 3055984071 | ||||||||
| Practice Location | |||||||||
| Address1: | 8940 N KENDALL DR | ||||||||
| Address2: | SUITE 504E | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331762148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055956200 | ||||||||
| FaxNumber: | 3055984071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2013 | ||||||||
| LastUpdateDate: | 12/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9107656 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA9107656 | 01 | FL | FLORIDA PHYSICIAN ASSISTANT LICENSE | OTHER |