Healthcare Provider Details

I. General information

NPI: 1679653182
Provider Name (Legal Business Name): PEDRO PABLO DIAZ-BORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2886 S OSCEOLA AVE
ORLANDO FL
32806-5431
US

IV. Provider business mailing address

3407 PHILS LN
APOPKA FL
32712-5409
US

V. Phone/Fax

Practice location:
  • Phone: 407-325-2032
  • Fax: 407-770-1792
Mailing address:
  • Phone: 407-325-2032
  • Fax: 407-770-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME 26065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: