Healthcare Provider Details

I. General information

NPI: 1811584220
Provider Name (Legal Business Name): JAVIER CONDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8657 JAMESTOWN DR
WINTER HAVEN FL
33884-4838
US

IV. Provider business mailing address

8657 JAMESTOWN DR
WINTER HAVEN FL
33884-4838
US

V. Phone/Fax

Practice location:
  • Phone: 407-375-3559
  • Fax:
Mailing address:
  • Phone: 407-375-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number853
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: