Provider Demographics
NPI:1225263957
Name:HARNISTH, MARIA SOLEDAD (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:SOLEDAD
Last Name:HARNISTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-414-7700
Mailing Address - Fax:954-840-0850
Practice Address - Street 1:5810 CORAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3374
Practice Address - Country:US
Practice Address - Phone:954-414-7700
Practice Address - Fax:954-840-0850
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2020-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME104597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000917800Medicaid