Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME107660 | FL |
Y | 111NI0900X | Internist | ME107660 | FL |
N | 207RH0002X | Hospice and Palliative Medicine | ME107660 | FL |
NPI | 1043410699 |
---|---|
Provider Name | Dr. Guillermo Izquierdo Pretel |
First Address | Miami, FL 33145-3256 |
Second Address | Miami, FL 33136-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 25/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME 107660 | STATE LICENSE (01) | FL |