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General NPI Number Information
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NPI Number | 1033165618
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Entity Type | Organization
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Legal Business Name | JOSE E DE LA GANDARA MD ANGELA PEDRAZA MD PA
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2161 PALM BEACH LAKES BLVD SUITE 215
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6607
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Country | US
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Telephone | 561-687-2111
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Fax | 561-687-1777
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Provider Business Mailing Address
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Address Line | 2161 PALM BEACH LAKES BLVD SUITE 215
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6607
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Country | US
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Telephone | 561-687-2111
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Fax | 561-687-1777
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Authorized Official
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Title or Position | CO OWNER
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Name | DR. JOSE E DE LA GANDARA
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Credential | MD
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Telephone | 561-687-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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