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Organization

KIDNEY DOCTOR, CORP.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
OTTO OSTOLAZA-GARCIA MD (OWNER/PRESIDENT)
(813) 873-1016
Entity
Organization

Contact information

Practice address
4710 N HABANA AVE STE 300, TAMPA, FL 33614-7151
(813) 873-1016
(813) 874-2813
Mailing address
111 N 12TH ST UNIT 1424, TAMPA, FL 33602-3674
(407) 718-6568

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010280100
FL
Enumeration date
12/04/2017
Last updated
12/04/2017
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