Basic Information
| Provider Information | |||||||||
| NPI: | 1881011260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAHAMONDE | ||||||||
| FirstName: | EMMANUEL | ||||||||
| MiddleName: | ISAAC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9202 NW 37TH PL | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330653045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876857181 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16401 NW 2ND AVE STE 203 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331696036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059990009 | ||||||||
| FaxNumber: | 3059457136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2014 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 19455 | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RN0300X | ME139931 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.