Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 9253642 | FL |
NPI | 1013425610 |
---|---|
Provider Name | Estuardo Del Peso |
First Address | Miami, FL 33174-1958 |
Second Address | Miami, FL 33174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2018 |
Last Update Date | 17/01/2018 |