Provider Demographics
NPI:1841946472
Name:FRANCISCO G TUDELA M.D PA
Entity type:Organization
Organization Name:FRANCISCO G TUDELA M.D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:G
Authorized Official - Last Name:TUDELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-691-1171
Mailing Address - Street 1:11760 SW 40TH ST STE 729
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8102
Mailing Address - Country:US
Mailing Address - Phone:305-559-8787
Mailing Address - Fax:844-798-8918
Practice Address - Street 1:11760 SW 40TH ST STE 729
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8102
Practice Address - Country:US
Practice Address - Phone:305-559-8787
Practice Address - Fax:844-798-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058554800Medicaid