Healthcare Provider Details

I. General information

NPI: 1699277426
Provider Name (Legal Business Name): MILDRED ELENA PASTORIZO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 RINGLING BLVD
SARASOTA FL
34237-6102
US

IV. Provider business mailing address

8618 GREAT MEADOW DR
SARASOTA FL
34238-3308
US

V. Phone/Fax

Practice location:
  • Phone: 941-861-2709
  • Fax:
Mailing address:
  • Phone: 941-587-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME83839
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: