Provider Demographics
NPI:1225265077
Name:IZQUIERDO, MARIA PADRON
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:PADRON
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 19TH STREET SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976
Mailing Address - Country:US
Mailing Address - Phone:239-369-0613
Mailing Address - Fax:
Practice Address - Street 1:2901 19TH ST SW
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-3656
Practice Address - Country:US
Practice Address - Phone:239-369-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 171465376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6906329OtherAGENCY OF HEALTHCARE ADMINISTRATION, DIV OF HEALTH QUALITY ASSURANCE