Provider Demographics
NPI:1619430832
Name:REMEDIOS, MARIA I
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:REMEDIOS
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 1:3762 MIL LAKE CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3424
Mailing Address - Country:US
Mailing Address - Phone:561-543-3018
Mailing Address - Fax:
Practice Address - Street 1:421 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4442
Practice Address - Country:US
Practice Address - Phone:561-275-1155
Practice Address - Fax:561-275-1156
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1979092106S00000X
FL11022984363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician