Individual
MARICELA DIANEXI FARDALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8051 W 24TH AVE STE 9, HIALEAH, FL 33016-5596
(305) 400-9702
(305) 735-7542
Mailing address
8051 W 24TH AVE STE 9, HIALEAH, FL 33016-5596
(305) 400-9702
(305) 735-7542
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103093
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004570500
—
FL
Enumeration date
08/11/2006
Last updated
07/13/2021
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