Healthcare Provider Details

I. General information

NPI: 1447976659
Provider Name (Legal Business Name): MICHEL ESTEBAN PADRON PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4596 MARINER BLVD
SPRING HILL FL
34609-1938
US

IV. Provider business mailing address

4596 MARINER BLVD
SPRING HILL FL
34609-1938
US

V. Phone/Fax

Practice location:
  • Phone: 352-777-5571
  • Fax:
Mailing address:
  • Phone: 352-777-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: