Provider Demographics
NPI:1417108879
Name:REDONDO HAND CENTER
Entity Type:Organization
Organization Name:REDONDO HAND CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/ CREDENTIALING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-412-2800
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:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0064553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty