Provider Demographics
NPI:1073177523
Name:HECTOR I PALLAVICINI MD PA
Entity Type:Organization
Organization Name:HECTOR I PALLAVICINI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLAVICINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-558-0411
Mailing Address - Street 1:3499 W 4TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4333
Mailing Address - Country:US
Mailing Address - Phone:305-558-0411
Mailing Address - Fax:305-863-3802
Practice Address - Street 1:3499 W 4TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4333
Practice Address - Country:US
Practice Address - Phone:305-558-0411
Practice Address - Fax:305-863-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative MedicineGroup - Single Specialty