Provider Demographics
NPI:1760555213
Name:MODERN TIMES WOMENS CARE PA
Entity Type:Organization
Organization Name:MODERN TIMES WOMENS CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-921-3090
Mailing Address - Street 1:7050 NW 4TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2247
Mailing Address - Country:US
Mailing Address - Phone:954-791-3090
Mailing Address - Fax:954-921-3166
Practice Address - Street 1:7050 NW 4TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2247
Practice Address - Country:US
Practice Address - Phone:954-791-3090
Practice Address - Fax:954-921-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85186207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277741000Medicaid
FL277741000Medicaid