Provider Demographics
NPI:1891839429
Name:ALLENDE, TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:ALLENDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 651250
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-1250
Mailing Address - Country:US
Mailing Address - Phone:305-274-4031
Mailing Address - Fax:305-274-4032
Practice Address - Street 1:7931 BIRD RD
Practice Address - Street 2:SUITE37
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6748
Practice Address - Country:US
Practice Address - Phone:305-274-4031
Practice Address - Fax:305-274-4032
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95319CMedicare ID - Type Unspecified