Provider Demographics
NPI:1568889897
Name:BALTODANO FALLAS, PABLO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:ANTONIO
Last Name:BALTODANO FALLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8396 SW 8TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4180
Mailing Address - Country:US
Mailing Address - Phone:305-615-4200
Mailing Address - Fax:
Practice Address - Street 1:8396 SW 8TH ST FL 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4180
Practice Address - Country:US
Practice Address - Phone:305-615-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147294208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery