| NPI | 1780083501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN FRANCISCO PRADO Owner 813-968-1373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL DN20896) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-18 |