Provider Demographics
NPI:1336487974
Name:JACQUELINE REDONDO MD PA
Entity Type:Organization
Organization Name:JACQUELINE REDONDO MD PA
Other - Org Name:REDONDO HAND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-898-5279
Mailing Address - Street 1:7130 SW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2511
Mailing Address - Country:US
Mailing Address - Phone:305-412-2800
Mailing Address - Fax:305-412-6045
Practice Address - Street 1:7130 SW 87TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2511
Practice Address - Country:US
Practice Address - Phone:305-412-2800
Practice Address - Fax:305-412-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 64553207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31341AOtherMEDICARE
FLF60055Medicare UPIN