Basic Information
| Provider Information | |||||||||
| NPI: | 1831786516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBERTUS | ||||||||
| FirstName: | DILMA | ||||||||
| MiddleName: | AMARILIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 W 54TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330122452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7868088361 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1475 W 49TH PL | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330123113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055582500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2020 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11010540 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.