Provider Demographics
NPI:1457543746
Name:DE FREITAS, IVEL CRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:IVEL
Middle Name:CRISTINA
Last Name:DE FREITAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IVEL
Other - Middle Name:C
Other - Last Name:DE FREITAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6030 REESE RD APT 406
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1243
Mailing Address - Country:US
Mailing Address - Phone:305-393-2477
Mailing Address - Fax:954-634-4293
Practice Address - Street 1:4765 SW 148TH AVE STE 404
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-2128
Practice Address - Country:US
Practice Address - Phone:203-300-0147
Practice Address - Fax:954-634-4293
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107216207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME107216OtherINTERNAL MEDICINE