Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 33254 | AL |
N | 2080P0208X | Pediatric Infectious Diseases | Q0443 | TX |
NPI | 1548492895 |
---|---|
Provider Name | Claudia Lorena Gaviria Agudelo |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106475200 | (05) | FL |
M1EFT | BLUE CROSS BLUE SHIELD (01) | FL |
MM528 | MEDICARE (01) | FL |