| NPI | 1902839913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE VANESSA MATOS Office Manager 813-960-4894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0061405) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2009-08-10 |