| Lydia Puente Pa | |
|
2645 Sw 37th Ave Ste 101 Miami FL 33133-2744 | |
| (305) 447-2317 | |
| (305) 447-2292 |
| Full Name | Lydia Puente Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 2645 Sw 37th Ave Ste 101, Miami, Florida |
| Authorized Official Name and Position | Lydia Puente (PRESIDENT) |
| Authorized Official Contact | 3054472317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lydia Puente Pa 2645 Sw 37th Ave Ste 101 Miami FL 33133-2744 Ph: (305) 447-2317 | Lydia Puente Pa 2645 Sw 37th Ave Ste 101 Miami FL 33133-2744 Ph: (305) 447-2317 |
| NPI Number | 1194115642 |
|---|---|
| Provider Enumeration Date | 02/04/2015 |
| Last Update Date | 02/04/2015 |
| Medicare PECOS PAC ID | 2961719026 |
|---|---|
| Medicare Enrollment ID | O20150922002191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194115642 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME80396 (Florida) | Primary |
| Provider Name | Lydia Puente |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942398714 PECOS PAC ID: 5193811784 Enrollment ID: I20071011000672 |
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