Provider Demographics
NPI:1437170545
Name:REDONDO, JACQUELINE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:REDONDO
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 1:5690 SW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1488
Mailing Address - Country:US
Mailing Address - Phone:305-412-1591
Mailing Address - Fax:
Practice Address - Street 1:7130 SW 87TH CT
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2511
Practice Address - Country:US
Practice Address - Phone:305-412-2800
Practice Address - Fax:305-412-6045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL64553207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31341AMedicare ID - Type Unspecified
FLF60055Medicare UPIN