| NPI | 1093254716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEDRO RAFAEL FAJARDO POMPA Owner/President 786-452-1751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2023-01-25 |