Basic Information
| Provider Information | |||||||||
| NPI: | 1780703793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONDE | ||||||||
| FirstName: | JANNETTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 400 | ||||||||
| Address2: | |||||||||
| City: | COTOPAXI | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812230400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192855121 | ||||||||
| FaxNumber: | 7192189994 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 N. PALM AVE | ||||||||
| Address2: | STE 303 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330263242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888526672 | ||||||||
| FaxNumber: | 3058914228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 08/05/2009 | ||||||||
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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 | 2084P0800X | ME102565 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000592200 | 05 | FL | MEDICAID |