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General NPI Number Information
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NPI Number | 1396981635
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Entity Type | Organization
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Legal Business Name | PASADENA CENTER FOR ASTHMA & LUNG DISORDERS LLC
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 5454 CENTRAL AVE STE A
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City | SAINT PETERSBURG
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State | FL
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Zip | 33707-6129
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Country | US
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Telephone | 727-347-5242
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Fax | 727-347-2402
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Provider Business Mailing Address
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Address Line | 5454 CENTRAL AVE STE A
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City | SAINT PETERSBURG
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State | FL
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Zip | 33707-6129
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Country | US
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Telephone | 727-347-5242
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Fax | 727-347-2402
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Authorized Official
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Title or Position | OWNER/MD
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Name | MOHAMED IBRAHIM ALI ELTOUM
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Credential | MD
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Telephone | 727-347-5242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME 100366
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License Number State | FL
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