Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 0051439 | FL |
NPI | 1093748428 |
---|---|
Provider Name | Jose Ramon Prieto |
First Address | Brandon, FL 33511-4849 |
Second Address | Brandon, FL 33511-4849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 21/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269481600 | (05) | FL |
G70136 | (02) | FL |