Provider Demographics
NPI:1194782821
Name:ALLENDE GINES, CARMEN E (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:E
Last Name:ALLENDE GINES
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 1:819 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5027
Mailing Address - Country:US
Mailing Address - Phone:407-288-8242
Mailing Address - Fax:407-490-1309
Practice Address - Street 1:819 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-288-8242
Practice Address - Fax:407-490-1309
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8323208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE67341Medicare UPIN
PR80213Medicare ID - Type Unspecified