Provider Demographics
NPI:1871787440
Name:NIDIA M IGLESIAS MD PA
Entity type:Organization
Organization Name:NIDIA M IGLESIAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-531-0820
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 560
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-531-0820
Mailing Address - Fax:305-531-0920
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 560
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-531-0820
Practice Address - Fax:305-531-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF08118Medicare UPIN