Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME-0078918 | FL |
NPI | 1669498952 |
---|---|
Provider Name | Dr. Leopoldo Malvezzi |
First Address | Miami, FL 33155-4000 |
Second Address | Miami, FL 33155-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30631200 | (05) | FL |