Healthcare Provider Details

I. General information

NPI: 1740507755
Provider Name (Legal Business Name): ORTHOPEDIC & RADIOLOGY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5406 HOOVER BLVD SUITE 18
TAMPA FL
33634-5330
US

IV. Provider business mailing address

5406 HOOVER BLVD SUITE 18
TAMPA FL
33634-5330
US

V. Phone/Fax

Practice location:
  • Phone: 813-880-7577
  • Fax: 813-880-7553
Mailing address:
  • Phone: 813-880-7577
  • Fax: 813-880-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC7378
License Number StateFL

VIII. Authorized Official

Name: MR. EDUARDO DELGADO LAGO
Title or Position: OWNER
Credential:
Phone: 813-880-7577