Individual
THESALEE NICOLA RANDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5955 POUCE DE LEON BLVD., CORAL GABLES, FL 33146
(305) 661-1515
(305) 662-3723
Mailing address
5955 POUCE DE LEON BLVD., CORAL GABLES, FL 33146
(305) 661-1515
(305) 662-3723
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
064250
GA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
MD036205
DC
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
ME117952
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003119777A
—
GA
Enumeration date
10/05/2006
Last updated
04/14/2014
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