Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | ME94774 | FL |
NPI | 1194822353 |
---|---|
Provider Name | Jary Pando |
First Address | Miami, FL 33144-2031 |
Second Address | Miami, FL 33186-1708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
68030 | BCBS FL (01) | |
I66369 | (02) |