Doctor Name: | HENRIETE D FAILLACE |
NPI Number: | 1780858258 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | ME0064004 |
Business Practice Address: | 2627 Ne 203rd St Ste 101 Aventura, FL - 331801945 |
Business Phone Number: | 3059352452 |
Business Fax Number: | |
Mailing Address: | 1000 Belle Meade Island Dr, MIAMI |
State: | FL |
Postal Code: | 331385252 |
Phone Number: | 3059352452 |
Fax Number: | |
NPI Enumeration Date: | 04/16/2008 |
NPI Last Update Date: | 04/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME0064004 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |