Healthcare Provider Details

I. General information

NPI: 1265008213
Provider Name (Legal Business Name): ADONIS PARDO DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 NW 97TH AVE
DORAL FL
33172-1413
US

IV. Provider business mailing address

2608 NW 97TH AVE
DORAL FL
33172-1413
US

V. Phone/Fax

Practice location:
  • Phone: 305-614-4844
  • Fax: 305-603-8614
Mailing address:
  • Phone: 305-614-4844
  • Fax: 305-603-8614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ADONIS R PARDO
Title or Position: DO/OWNER
Credential: DO
Phone: 305-614-4844