Provider Demographics
NPI:1770940934
Name:RENDON DE DAHER, MARIA ELENA (RN,MW,SA-C, EO)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:RENDON DE DAHER
Suffix:
Gender:F
Credentials:RN,MW,SA-C, EO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10936 NW 67TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3744
Mailing Address - Country:US
Mailing Address - Phone:786-514-8272
Mailing Address - Fax:
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-693-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9470901163W00000X
FL343176B00000X
FL3246225500000X
FL14-346246ZC0007X
FLARNP11004836363L00000X
FLAPRN11004836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner