Healthcare Provider Details

I. General information

NPI: 1689708844
Provider Name (Legal Business Name): JOSE R PRIETO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 MORRISON RD STE 104
BRANDON FL
33511-4849
US

IV. Provider business mailing address

214 MORRISON RD STE 104
BRANDON FL
33511-4849
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-6474
  • Fax:
Mailing address:
  • Phone: 813-681-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: JOSEFINA RIVERA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 813-681-6474