MEDICARE: ERIK N PANDO OPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1053747857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK N PANDO OPA-C

Provider Business Mailing Address
First Line	:	9015 SWEETWATER DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-5152
Country	:	US
Telephone Number	:	214-673-8487
Fax Number	:

Provider Business Practice Location Address
First Line	:	9015 SWEETWATER DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-5152
Country	:	US
Telephone Number	:	214-673-8487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	09/25/2013

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