1730337023 NPI number — DAVID S RONDON MD PA

Table of content: (NPI 1730337023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730337023 NPI number — DAVID S RONDON MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID S RONDON MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1730337023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-2788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-694-8945
Provider Business Mailing Address Fax Number:
561-694-8688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-2788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-694-8945
Provider Business Practice Location Address Fax Number:
561-694-8688
Provider Enumeration Date:
08/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOMONACO
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL BILLING MANAGER
Authorized Official Telephone Number:
561-694-8945

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  ME052020 , 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: 047520300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113685900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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