Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | ME90704 | FL |
NPI | 1033280565 |
---|---|
Provider Name | Dr. Ernesto Cardozo |
First Address | Pembroke Pines, FL 33024-6171 |
Second Address | Pembroke Pines, FL 33024-6171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 05/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME90704 | MED LICENSE (01) | FL |