Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | ME62950 | FL |
NPI | 1053416412 |
---|---|
Provider Name | Alejandro Carvallo |
First Address | Zephyrhills, FL 33542 |
Second Address | Zephyrhills, FL 33542-0600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 30/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18832U | TPA MEDICARE# (01) | FL |
373724100 | (05) | FL |
390007562 | RR MEDICARE (01) | FL |
F61936 | (02) |