Provider Demographics
NPI:1912646415
Name:CIFUENTES, ANGELICA M (OD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:M
Last Name:CIFUENTES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15233 SW 37TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4770
Mailing Address - Country:US
Mailing Address - Phone:305-903-0683
Mailing Address - Fax:
Practice Address - Street 1:10101 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1808
Practice Address - Country:US
Practice Address - Phone:305-227-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6097152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist