Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME54683 | FL |
NPI | 1013962851 |
---|---|
Provider Name | Rube J Pardo |
First Address | Coral Gables, FL 33114 |
Second Address | Coral Gables, FL 33134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 02/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E22559 | (02) |