=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043510506
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INHEALTH MD ALLIANCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2010
-----------------------------------------------------
Last Update Date | 10/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8367 VIA ROSA
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32836-8788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-745-1142
-----------------------------------------------------
Fax | 407-386-7304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8367 VIA ROSA
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32836-8788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-745-1142
-----------------------------------------------------
Fax | 407-386-7304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. NELSON M PICHARDO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-970-3931
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------