Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH8999 | FL |
NPI | 1831260660 |
---|---|
Provider Name | Juan Carlos Conde |
First Address | Delray Beach, FL 33484-6406 |
Second Address | Delray Beach, FL 33444-3689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 23/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64163 | BCBS (01) | FL |