Provider Demographics
NPI:1568450955
Name:ORDILLAS-JORGE, LYNDIA (MD)
Entity Type:Individual
Prefix:
First Name:LYNDIA
Middle Name:
Last Name:ORDILLAS-JORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNDIA
Other - Middle Name:
Other - Last Name:JORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2055
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:305-756-5757
Practice Address - Street 1:6269 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-4394
Practice Address - Country:US
Practice Address - Phone:305-756-9977
Practice Address - Fax:184-447-3296
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378581500Medicaid
27865YMedicare ID - Type Unspecified