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Organization
LOURDES LORETO MD PA
Active
Organization
LOURDES LORETO MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOURDES LORETO MD (PHYSICIAN)
(813) 877-3902
Entity
Organization
Contact information
Practice address
4710 N HABANA AVE, 202, TAMPA, FL 33614
(813) 877-3902
(813) 877-3807
Mailing address
4710 N HABANA AVE, 202, TAMPA, FL 33614
(813) 877-3902
(813) 877-3807
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME29045
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057966100
—
FL
01
—
29972
BLUE CROSS BLUE SHIELD
FL
01
—
407112745
RAILROAD MEDICARE
FL
Enumeration date
08/06/2007
Last updated
03/05/2008
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