Provider Demographics
NPI:1528057882
Name:CUADRADO-VENDETTI, GINA (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CUADRADO-VENDETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21150 BISCAYNE BLVD
Mailing Address - Street 2:AVENTURA
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1226
Mailing Address - Country:US
Mailing Address - Phone:305-466-9988
Mailing Address - Fax:
Practice Address - Street 1:21150 BISCAYNE BLVD
Practice Address - Street 2:AVENTURA
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1226
Practice Address - Country:US
Practice Address - Phone:305-466-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91051208000000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270682200Medicaid
FL270682200Medicaid