Basic Information
| Provider Information | |||||||||
| NPI: | 1821003799 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OSPINA-HERRERA | ||||||||
| FirstName: | LORRAINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 SW 87TH AVE | ||||||||
| Address2: | SUITE C-350 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331732539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547319676 | ||||||||
| FaxNumber: | 9547319747 | ||||||||
| Practice Location | |||||||||
| Address1: | 7800 SW 87TH AVENUE | ||||||||
| Address2: | C-350 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331732539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052714711 | ||||||||
| FaxNumber: | 3052718732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME90828 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 270425100 | 05 | FL | MEDICAID |