Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | ME75740 | FL |
NPI | 1467433318 |
---|---|
Provider Name | Dr. Magdalen Gondor |
First Address | St Petersburg, FL 33701-4804 |
Second Address | St Petersburg, FL 33701-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 18/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254042800 | (05) | FL |
H54424 | (02) | FL |