Provider Demographics
NPI:1598934143
Name:ISRAEL CRESPO MD PA
Entity Type:Organization
Organization Name:ISRAEL CRESPO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-997-0071
Mailing Address - Street 1:6919 N DALE MABRY HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3860
Mailing Address - Country:US
Mailing Address - Phone:813-930-8816
Mailing Address - Fax:813-932-1856
Practice Address - Street 1:6919 N DALE MABRY HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-930-8816
Practice Address - Fax:813-932-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377776600Medicaid
FL377776600Medicaid
FLG01068Medicare UPIN