Healthcare Provider Details

I. General information

NPI: 1326007584
Provider Name (Legal Business Name): ELISEO J RONDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST DEPT. OF CRITICAL CARE MEDICINE
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

3501 JOHNSON ST DEPT. OF CRITICAL CARE MEDICINE
HOLLYWOOD FL
33021-5421
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-2020
  • Fax: 954-965-5396
Mailing address:
  • Phone: 954-987-2020
  • Fax: 954-965-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME96741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: