Healthcare Provider Details

I. General information

NPI: 1013244482
Provider Name (Legal Business Name): DUVER GIRALDO ARDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3947 PEACE PIPE DR
ORLANDO FL
32829-8416
US

IV. Provider business mailing address

3947 PEACE PIPE DR
ORLANDO FL
32829-8416
US

V. Phone/Fax

Practice location:
  • Phone: 407-496-2289
  • Fax: 407-249-0885
Mailing address:
  • Phone: 407-496-2289
  • Fax: 407-249-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberARDMS 39408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: