Provider Demographics
NPI:1992906564
Name:CONSUEGRA, YUDITH (CPHT)
Entity type:Individual
Prefix:MRS
First Name:YUDITH
Middle Name:
Last Name:CONSUEGRA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17796 SW 146TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7667
Mailing Address - Country:US
Mailing Address - Phone:786-573-3115
Mailing Address - Fax:
Practice Address - Street 1:11629 SW 216TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-2908
Practice Address - Country:US
Practice Address - Phone:305-278-4455
Practice Address - Fax:305-278-4456
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician