Provider Demographics
NPI:1205889854
Name:FALEN, MARIA TERESA (MD)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:TERESA
Last Name:FALEN
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 1:17190 SW 94TH AVE
Mailing Address - Street 2:APT N' 906
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4445
Mailing Address - Country:US
Mailing Address - Phone:305-801-8276
Mailing Address - Fax:305-255-3973
Practice Address - Street 1:3271 NW 7TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4141
Practice Address - Country:US
Practice Address - Phone:305-253-1660
Practice Address - Fax:305-253-5775
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 90697208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI36005Medicare UPIN
FLU5241Medicare ID - Type UnspecifiedMEDICARE