Provider Demographics
NPI:1083297766
Name:DE LA FLOR, RENATO
Entity Type:Individual
Prefix:
First Name:RENATO
Middle Name:
Last Name:DE LA FLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 SW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5508
Mailing Address - Country:US
Mailing Address - Phone:786-203-0604
Mailing Address - Fax:
Practice Address - Street 1:6161 BLUE LAGOON DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2057
Practice Address - Country:US
Practice Address - Phone:786-388-1400
Practice Address - Fax:786-388-1401
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily