Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 064250 | GA |
N | 2080P0204X | Pediatric Emergency Doctor | MD036205 | DC |
Y | 2080P0204X | Pediatric Emergency Doctor | ME117952 | FL |
NPI | 1194811158 |
---|---|
Provider Name | Thesalee Nicola Randon |
First Address | Coral Gables, FL 33146 |
Second Address | Coral Gables, FL 33146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 14/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003119777A | (05) | GA |