Provider Demographics
NPI:1609259209
Name:ANDRADE PAZ, HUGO
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:ANDRADE PAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13782 PLANTATION RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4462
Mailing Address - Country:US
Mailing Address - Phone:917-580-2810
Mailing Address - Fax:
Practice Address - Street 1:13782 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4462
Practice Address - Country:US
Practice Address - Phone:813-910-0030
Practice Address - Fax:813-971-6473
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295922207RN0300X
390200000X
FLME150815207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty