Provider Demographics
NPI:1073511333
Name:AMENDOLA, BEATRIZ ELENA (MD)
Entity type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:ELENA
Last Name:AMENDOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431453
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-1453
Mailing Address - Country:US
Mailing Address - Phone:305-669-6833
Mailing Address - Fax:305-666-4030
Practice Address - Street 1:5995 SW 71ST ST STE 1-A
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3531
Practice Address - Country:US
Practice Address - Phone:305-669-6833
Practice Address - Fax:305-666-4030
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2020-10-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
FLME584112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062272900Medicaid
FLB41046Medicare UPIN
FL09871AMedicare ID - Type Unspecified