Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | ME 65669 | FL |
NPI | 1063512960 |
---|---|
Provider Name | Edgardo B. Penabad |
First Address | Hialeah, FL 33013-3823 |
Second Address | Hialeah, FL 33013-3823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
375873700 | (05) | FL |
H89040 | (02) | FL |