1710969688 NPI number — FERNANDO C TRESPALACIOS MD

Table of content: FERNANDO C TRESPALACIOS MD (NPI 1710969688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710969688 NPI number — FERNANDO C TRESPALACIOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRESPALACIOS
Provider First Name:
FERNANDO
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710969688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9193 SUNSET DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33173-3487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-273-9377
Provider Business Mailing Address Fax Number:
305-273-9388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9193 SUNSET DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-3487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-273-9377
Provider Business Practice Location Address Fax Number:
305-273-9388
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  ME91609 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051203 . This is a "NHP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 270979100 . This is a "PSN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 270979100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0275248 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 296787 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 270979100 . This is a "SOUTH FLORIDA COMMUNITY CARE NETWORK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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