Provider Demographics
NPI:1811086630
Name:ANTUN, MAYDA CARIDAD (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:MAYDA
Middle Name:CARIDAD
Last Name:ANTUN
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 SW 89TH ST
Mailing Address - Street 2:APT. PH53
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7683
Mailing Address - Country:US
Mailing Address - Phone:305-632-5040
Mailing Address - Fax:
Practice Address - Street 1:7350 SW 89TH ST
Practice Address - Street 2:APT. PH53
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7683
Practice Address - Country:US
Practice Address - Phone:305-632-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0453706Medicaid
FL0453706Medicaid
FLD64012Medicare UPIN