Basic Information
| Provider Information | |||||||||
| NPI: | 1609935709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAREDES | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | ANTONIO | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4998 10TH AVE N | ||||||||
| Address2: | |||||||||
| City: | GREENACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334632210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612932900 | ||||||||
| FaxNumber: | 5614088860 | ||||||||
| Practice Location | |||||||||
| Address1: | 4998 10TH AVE N | ||||||||
| Address2: | |||||||||
| City: | GREENACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334632210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612932900 | ||||||||
| FaxNumber: | 5614088860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME98438 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000636900 | 05 | FL | MEDICAID | 31062 | 01 | FL | BCBS | OTHER | 9385105 | 01 | AETNA | OTHER |