Provider Demographics
NPI:1407034283
Name:FUNDORA, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:FUNDORA
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 1:8888 NW 189TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6238
Mailing Address - Country:US
Mailing Address - Phone:305-829-9332
Mailing Address - Fax:
Practice Address - Street 1:8888 NW 189TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6238
Practice Address - Country:US
Practice Address - Phone:305-829-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist