=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366630873
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADONIS PARDO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2007
-----------------------------------------------------
Last Update Date | 03/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3059 HIBISCUS ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33133-4340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-962-7341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 760 PONCE DE LEON BLVD SUITE 107A
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-962-7341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | ADONIS PARDO
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 305-962-7341
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO3287
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS 11446
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------