Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 247405 | MA |
Y | 207K00000X | Allergist & Immunologist | ME133105 | FL |
N | 207R00000X | Internist | 12022R | PR |
N | 111NI0900X | Internist | 12022R | PR |
NPI | 1003071713 |
---|---|
Provider Name | Juan Carlos Cardet Guisasaola |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33612-6601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2008 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022650100 | (05) | FL |
IFANC | BLUE CROSS BLUE SHIELD (01) | FL |