Provider Demographics
NPI:1316190358
Name:DE ARMENDI, ANGEL A
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:A
Last Name:DE ARMENDI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ANGEL
Other - Middle Name:A
Other - Last Name:DE ARMENDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9725 NW 117TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1260
Mailing Address - Country:US
Mailing Address - Phone:954-432-0578
Mailing Address - Fax:
Practice Address - Street 1:5190 NW 167TH ST STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6329
Practice Address - Country:US
Practice Address - Phone:855-226-6633
Practice Address - Fax:844-224-2818
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17369174400000X
FLACN460208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist