Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ACK | OH |
N | 111NI0900X | Internist | ACK | OH |
Y | 207RA0201X | Internist - Allergy & Immunology | ME135311 | FL |
NPI | 1962843706 |
---|---|
Provider Name | Lyda Cuervo Pardo |
First Address | Gainesville, FL 32610-3003 |
Second Address | Gainesville, FL 32610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2013 |
Last Update Date | 21/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025172300 | (05) | FL |