Healthcare Provider Details

I. General information

NPI: 1063986321
Provider Name (Legal Business Name): CLAUDIO ANDRES MEDERO TORRES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 SW 1ST AVE
OCALA FL
34471-6500
US

IV. Provider business mailing address

5657 SW 40TH PL
OCALA FL
34474-9591
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1000
  • Fax:
Mailing address:
  • Phone: 352-581-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11001059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: