Healthcare Provider Details

I. General information

NPI: 1396981635
Provider Name (Legal Business Name): PASADENA CENTER FOR ASTHMA & LUNG DISORDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 03/19/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 CENTRAL AVE STE A
SAINT PETERSBURG FL
33707-6129
US

IV. Provider business mailing address

5454 CENTRAL AVE STE A
SAINT PETERSBURG FL
33707-6129
US

V. Phone/Fax

Practice location:
  • Phone: 727-347-5242
  • Fax: 727-347-2402
Mailing address:
  • Phone: 727-347-5242
  • Fax: 727-347-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME 100366
License Number StateFL

VIII. Authorized Official

Name: MOHAMED IBRAHIM ALI ELTOUM
Title or Position: OWNER/MD
Credential: MD
Phone: 727-347-5242