| NPI | 1184130742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE L SOTOMAYOR-LEYVA Owner 813-512-2564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2022-07-06 |