Provider Demographics
NPI:1780820225
Name:ODALYS P FRONTELA M D P A
Entity type:Organization
Organization Name:ODALYS P FRONTELA M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ODALYS
Authorized Official - Middle Name:P
Authorized Official - Last Name:FRONTELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-698-7172
Mailing Address - Street 1:801 W 48TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3541
Mailing Address - Country:US
Mailing Address - Phone:305-698-7172
Mailing Address - Fax:305-698-7649
Practice Address - Street 1:801 W 48TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3541
Practice Address - Country:US
Practice Address - Phone:305-698-7172
Practice Address - Fax:305-698-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty