Provider Demographics
NPI:1477663805
Name:AESHTOR E BOMBINO MDPA
Entity Type:Organization
Organization Name:AESHTOR E BOMBINO MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AESTHOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-275-7373
Mailing Address - Street 1:10651 N KENDALL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1569
Mailing Address - Country:US
Mailing Address - Phone:305-275-7373
Mailing Address - Fax:305-275-7066
Practice Address - Street 1:10651 N KENDALL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1569
Practice Address - Country:US
Practice Address - Phone:305-275-7373
Practice Address - Fax:305-275-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51681Medicare PIN