Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | ME123243 | FL |
NPI | 1366715799 |
---|---|
Provider Name | Frank William Ayestaran Cassani |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2012 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015229500 | (05) | FL |
150KZ | BLUE CROSS BLUE SHIELD (01) | FL |