1467622985 NPI number — DR. RICARDO EMILIO OGANDO DELEON MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467622985 NPI number — DR. RICARDO EMILIO OGANDO DELEON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGANDO DELEON
Provider First Name:
RICARDO
Provider Middle Name:
EMILIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OGANDO DELEON
Provider Other First Name:
RICARDO
Provider Other Middle Name:
EMILIO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467622985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3090 CARUSO CT STE 50
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-8510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-481-7179
Provider Business Mailing Address Fax Number:
407-481-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 W STATE ROAD 434
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32750-5119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-842-2994
Provider Business Practice Location Address Fax Number:
407-767-5801
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301091503 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME110429 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003738100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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