1679653182 NPI number — DR. PEDRO PABLO DIAZ-BORDON MD

Table of content: DR. PEDRO PABLO DIAZ-BORDON MD (NPI 1679653182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679653182 NPI number — DR. PEDRO PABLO DIAZ-BORDON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ-BORDON
Provider First Name:
PEDRO
Provider Middle Name:
PABLO
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679653182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3407 PHILS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APOPKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32712-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-325-2032
Provider Business Mailing Address Fax Number:
407-770-1792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2886 S OSCEOLA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-5431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-325-2032
Provider Business Practice Location Address Fax Number:
407-770-1792
Provider Enumeration Date:
10/17/2006

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: 207VG0400X , with the licence number:  ME 26065 , 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)





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