Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME 21226 | FL |
NPI | 1083883284 |
---|---|
Provider Name | Dr. Diego A Bognolo |
First Address | Tampa, FL 33618-4434 |
Second Address | Tampa, FL 33618-4434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2008 |
Last Update Date | 21/02/2008 |