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General NPI Number Information
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NPI Number | 1154143592
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Entity Type | Organization
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Legal Business Name | YANINA ABAUNZA-FIALLOS MD PA
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1037 PROFESSIONAL PARK DR
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City | BRANDON
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State | FL
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Zip | 33511-4886
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Country | US
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Telephone | 813-684-5659
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Fax | 813-685-2640
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Provider Business Mailing Address
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Address Line | 17541 N DALE MABRY HWY
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City | LUTZ
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State | FL
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Zip | 33548-4521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GOWTHAMAN PANDIAN
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Credential |
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Telephone | 813-964-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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