Provider Demographics
NPI:1336805407
Name:LIMONTE, IDANIA
Entity Type:Individual
Prefix:
First Name:IDANIA
Middle Name:
Last Name:LIMONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 NW 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2023
Mailing Address - Country:US
Mailing Address - Phone:786-499-2918
Mailing Address - Fax:786-409-4152
Practice Address - Street 1:1603 NW 28TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2023
Practice Address - Country:US
Practice Address - Phone:786-499-2918
Practice Address - Fax:786-409-4152
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023898500Medicaid