Provider Demographics
NPI:1407515380
Name:BEATRIZ E AMENDOLA MD PA
Entity Type:Organization
Organization Name:BEATRIZ E AMENDOLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:AMENDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-669-6833
Mailing Address - Street 1:5995 SW 71ST ST # 1-A
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3531
Mailing Address - Country:US
Mailing Address - Phone:305-669-6833
Mailing Address - Fax:
Practice Address - Street 1:96 W 21ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2614
Practice Address - Country:US
Practice Address - Phone:305-669-6833
Practice Address - Fax:305-666-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty