Healthcare Provider Details

I. General information

NPI: 1578793493
Provider Name (Legal Business Name): ANDREW RIANO OBANDO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 S FALKENBURG RD
RIVERVIEW FL
33578-2574
US

IV. Provider business mailing address

3140 S FALKENBURG RD
RIVERVIEW FL
33578-2574
US

V. Phone/Fax

Practice location:
  • Phone: 706-442-9000
  • Fax: 855-785-2883
Mailing address:
  • Phone: 706-442-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: