Organization
SERGIO H. VALLEJO M. D. , P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE JORDAN (SECRETARY)
(863) 688-0512
Entity
Organization
Contact information
Practice address
1543 LAKELAND HILLS BLVD, LAKELAND, FL 33805-3246
(863) 688-0512
(863) 686-6895
Mailing address
1543 LAKELAND HILLS BLVD, LAKELAND, FL 33805-3246
(863) 688-0512
(863) 686-6895
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
ME23925
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258723800
—
FL
01
—
K1372
MEDICARE PART B
FL
Enumeration date
02/05/2008
Last updated
08/16/2010
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