Provider Demographics
NPI:1447643291
Name:IDITALYA 10 MEDICAL CENTER INC
Entity type:Organization
Organization Name:IDITALYA 10 MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-877-4201
Mailing Address - Street 1:3430 W LAMBRIGHT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4750
Mailing Address - Country:US
Mailing Address - Phone:813-877-4201
Mailing Address - Fax:727-498-0672
Practice Address - Street 1:3430 W LAMBRIGHT ST STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4750
Practice Address - Country:US
Practice Address - Phone:813-877-4201
Practice Address - Fax:727-498-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty