Basic Information
Provider Information
NPI: 1003002817
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: IGLESIAS
FirstName: NAYVIS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3650 NW 82ND AVE
Address2: SUITE 502
City: DORAL
State: FL
PostalCode: 331666658
CountryCode: US
TelephoneNumber: 3055949333
FaxNumber: 3055940440
Practice Location
Address1: 3650 NW 82ND AVE
Address2: SUITE 502
City: DORAL
State: FL
PostalCode: 331666658
CountryCode: US
TelephoneNumber: 3055949333
FaxNumber: 3055940440
Other Information
ProviderEnumerationDate: 09/15/2007
LastUpdateDate: 02/09/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XME 102265FLY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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