Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW410 | FL |
NPI | 1114699907 |
---|---|
Provider Name | Jorge Alberto Urdaneta Aqui |
First Address | Hialeah, FL 33018-2076 |
Second Address | Hollywood, FL 33020-6703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2021 |
Last Update Date | 22/11/2021 |