Provider Demographics
NPI:1508695107
Name:FUNDORA, MARIA DE LOS ANGELES (NP)
Entity type:Individual
Prefix:
First Name:MARIA DE LOS ANGELES
Middle Name:
Last Name:FUNDORA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4271
Mailing Address - Country:US
Mailing Address - Phone:786-619-3360
Mailing Address - Fax:786-619-3360
Practice Address - Street 1:962 SW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4271
Practice Address - Country:US
Practice Address - Phone:786-619-3360
Practice Address - Fax:786-619-3360
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily