Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | ME101267 | FL |
NPI | 1215100425 |
---|---|
Provider Name | Alejandro Jordan Villegas |
First Address | Orlando, FL 32806-1101 |
Second Address | Orlando, FL 32806-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 18/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003502400 | (05) | FL |
ME101267 | MEDICAL LICENSE (01) | FL |