Provider Demographics
NPI:1841210812
Name:IGLESIAS, NIDIA M (MD)
Entity Type:Individual
Prefix:
First Name:NIDIA
Middle Name:M
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 560
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-531-0820
Mailing Address - Fax:305-531-0920
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE-560
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-531-0820
Practice Address - Fax:305-531-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59981207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12977OtherBCBS
FL943062OtherUNITED HEALTHCARE
FL000276OtherPREFERRED CARE PARTNERS
FL205912OtherAVMED
FL41249OtherNHP
FLP3158955OtherOXFORD HEALTH PLAN
FL12977Medicare PIN