Provider Demographics
NPI:1831281237
Name:NODAL, ALINA R (MD)
Entity Type:Individual
Prefix:MRS
First Name:ALINA
Middle Name:R
Last Name:NODAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ALINA
Other - Middle Name:R
Other - Last Name:CORDOVES NODAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5951 NW 173RD DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5112
Mailing Address - Country:US
Mailing Address - Phone:305-557-1030
Mailing Address - Fax:305-557-9757
Practice Address - Street 1:5951 NW 173 DR.
Practice Address - Street 2:SUITE 7
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:305-557-1030
Practice Address - Fax:305-557-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375476600Medicaid
FL25322Medicare ID - Type Unspecified
FL375476600Medicaid