Basic Information
| Provider Information | |||||||||
| NPI: | 1558383364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORORI | ||||||||
| FirstName: | FREDDY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5607 NW 27TH AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331422826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056376400 | ||||||||
| FaxNumber: | 3056365155 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 E 10TH AVE | ||||||||
| Address2: | BAY 39 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330103762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056376400 | ||||||||
| FaxNumber: | 3056365155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME66370 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 376504100 | 05 | FL | MEDICAID | 172687 | 01 | FL | WELLCARE | OTHER | 25965 | 01 | FL | BCBS | OTHER |