Provider Demographics
NPI:1851840854
Name:ALTIDOR, ESTHER (LPN)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:ALTIDOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16242 SW 28TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5211
Mailing Address - Country:US
Mailing Address - Phone:954-682-1173
Mailing Address - Fax:
Practice Address - Street 1:4026 NW 38TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33309-4813
Practice Address - Country:US
Practice Address - Phone:954-268-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-02
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1114201164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse