Provider Demographics
NPI:1295336337
Name:LOREDO, EDUARDO WILFREDO (ARNP)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:WILFREDO
Last Name:LOREDO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 NW 156TH ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2226
Mailing Address - Country:US
Mailing Address - Phone:786-521-0534
Mailing Address - Fax:
Practice Address - Street 1:2930 NW 156TH ST
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2226
Practice Address - Country:US
Practice Address - Phone:786-521-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9262047363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner