Provider Demographics
NPI:1992490668
Name:MARIDUENA, RICHARD ALFREDO
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALFREDO
Last Name:MARIDUENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8187 NW 8TH ST APT 213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2895
Mailing Address - Country:US
Mailing Address - Phone:786-512-6288
Mailing Address - Fax:
Practice Address - Street 1:714 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-4332
Practice Address - Country:US
Practice Address - Phone:786-655-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024378363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology