Provider Demographics
NPI:1407454838
Name:DE LAS CASAS, FREDDY (NP)
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:
Last Name:DE LAS CASAS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13940 SW 156TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1081
Mailing Address - Country:US
Mailing Address - Phone:305-967-0128
Mailing Address - Fax:
Practice Address - Street 1:13940 SW 156TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1081
Practice Address - Country:US
Practice Address - Phone:305-967-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily