Provider Demographics
NPI:1194115642
Name:LYDIA PUENTE PA
Entity type:Organization
Organization Name:LYDIA PUENTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-447-2317
Mailing Address - Street 1:2645 SW 37TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2744
Mailing Address - Country:US
Mailing Address - Phone:305-447-2317
Mailing Address - Fax:305-447-2292
Practice Address - Street 1:2645 SW 37TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2744
Practice Address - Country:US
Practice Address - Phone:305-447-2317
Practice Address - Fax:305-447-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty