Provider Demographics
NPI:1619292505
Name:NEGRON, EDELVIS
Entity Type:Individual
Prefix:
First Name:EDELVIS
Middle Name:
Last Name:NEGRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 W FLAGLER ST
Mailing Address - Street 2:SUITE # 218A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2045
Mailing Address - Country:US
Mailing Address - Phone:305-554-5686
Mailing Address - Fax:305-554-5680
Practice Address - Street 1:8420 W FLAGLER ST
Practice Address - Street 2:SUITE # 218A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2045
Practice Address - Country:US
Practice Address - Phone:305-554-5686
Practice Address - Fax:305-554-5680
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCCU8713208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice