Healthcare Provider Details

I. General information

NPI: 1568959682
Provider Name (Legal Business Name): YUDITH PANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 NW 27TH AVE
MIAMI FL
33147-7734
US

IV. Provider business mailing address

7925 NW 12TH ST STE 201
DORAL FL
33126-1821
US

V. Phone/Fax

Practice location:
  • Phone: 305-960-7668
  • Fax: 786-310-7347
Mailing address:
  • Phone: 305-874-3909
  • Fax: 305-874-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP9398403
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04180293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: