Provider Demographics
NPI:1902927163
Name:CONDARCO-PELAEZ, ABRAHAM
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:CONDARCO-PELAEZ
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 1:1260 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3806
Mailing Address - Country:US
Mailing Address - Phone:305-229-5843
Mailing Address - Fax:308-822-1269
Practice Address - Street 1:1260 LENOX AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3806
Practice Address - Country:US
Practice Address - Phone:305-229-5843
Practice Address - Fax:308-822-1269
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034273207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0034273OtherFLORIDA LICENSE #
FL274668900Medicaid
FL95640OtherBLUE SHIELD #
FLD67415Medicare UPIN
FL95640OtherBLUE SHIELD #