Healthcare Provider Details

I. General information

NPI: 1013843713
Provider Name (Legal Business Name): ARIEL ALEJANDRO PARDO ROGRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 BAY LAKE TRL
OLDSMAR FL
34677-4309
US

IV. Provider business mailing address

641 BAY LAKE TRL
OLDSMAR FL
34677-4309
US

V. Phone/Fax

Practice location:
  • Phone: 585-449-1330
  • Fax:
Mailing address:
  • Phone: 585-449-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3210
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: