Provider Demographics
NPI:1225701998
Name:EGLANTIN, FRIDNY
Entity Type:Individual
Prefix:
First Name:FRIDNY
Middle Name:
Last Name:EGLANTIN
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 1:8301 NW 4TH AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2670
Mailing Address - Country:US
Mailing Address - Phone:786-985-7814
Mailing Address - Fax:
Practice Address - Street 1:8301 NW 4TH AVE APT C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2670
Practice Address - Country:US
Practice Address - Phone:786-985-7814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-439246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant