Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 18310 | FL |
N | 208000000X | Pediatrician | A124092 | CA |
N | 2080P0208X | Pediatric Infectious Diseases | 9882 | SD |
Y | 2080P0208X | Pediatric Infectious Diseases | ME152081 | FL |
NPI | 1073952024 |
---|---|
Provider Name | Fernando Jose Bula-Rudas |
First Address | Jacksonville, FL 32216-6190 |
Second Address | St Petersburg, FL 33701-4804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 15/08/2021 |