Provider Demographics
NPI:1487756722
Name:LAUDERMAN REGALADO, ELDA PILAR (MD)
Entity type:Individual
Prefix:MRS
First Name:ELDA
Middle Name:PILAR
Last Name:LAUDERMAN REGALADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELDA
Other - Middle Name:PILAR
Other - Last Name:REGALADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14441 SW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3787
Mailing Address - Country:US
Mailing Address - Phone:954-430-4167
Mailing Address - Fax:
Practice Address - Street 1:15600 NW 67TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2175
Practice Address - Country:US
Practice Address - Phone:305-760-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374529500Medicaid
F75008Medicare UPIN
23850ZMedicare ID - Type Unspecified