Provider Demographics
NPI:1740545201
Name:ANDRADE, GLADYS LIZZETTE (MD)
Entity type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:LIZZETTE
Last Name:ANDRADE
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 1:61 HOOK SQ
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4401
Mailing Address - Country:US
Mailing Address - Phone:305-884-8880
Mailing Address - Fax:
Practice Address - Street 1:3500 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6809
Practice Address - Country:US
Practice Address - Phone:754-231-0164
Practice Address - Fax:754-225-1616
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN463208D00000X
PR18486208D00000X
FLME134772208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice