Provider Demographics
NPI:1558111559
Name:PADRON PROENZA, BELKIS
Entity Type:Individual
Prefix:
First Name:BELKIS
Middle Name:
Last Name:PADRON PROENZA
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 1:10375 W 33RD WAY
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2094
Mailing Address - Country:US
Mailing Address - Phone:786-493-2962
Mailing Address - Fax:
Practice Address - Street 1:10375 W 33RD WAY
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2094
Practice Address - Country:US
Practice Address - Phone:786-493-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily