Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME117328 | FL |
NPI | 1053692335 |
---|---|
Provider Name | Fernando Manuel Vargas Madueno |
First Address | Miramar, FL 33025-3925 |
Second Address | Pembroke Pines, FL 33028-1021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2011 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021446400 | (05) | FL |