Healthcare Provider Details

I. General information

NPI: 1194822353
Provider Name (Legal Business Name): JARY PANDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SW 88TH ST
MIAMI FL
33186-1708
US

IV. Provider business mailing address

8660 W FLAGLER ST SUITE #200
MIAMI FL
33144-2031
US

V. Phone/Fax

Practice location:
  • Phone: 305-227-5176
  • Fax: 305-554-4828
Mailing address:
  • Phone: 305-227-5176
  • Fax: 305-554-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME94774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: