Provider Demographics
NPI:1700834439
Name:PARDO TORO, LUIS EDUARDO (MD)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:EDUARDO
Last Name:PARDO TORO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2275 N VOLUSIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-2833
Mailing Address - Country:US
Mailing Address - Phone:386-774-0109
Mailing Address - Fax:386-774-1203
Practice Address - Street 1:2275 N VOLUSIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-2833
Practice Address - Country:US
Practice Address - Phone:386-774-0109
Practice Address - Fax:386-774-1203
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL146109207V00000X
PR13961207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREX170AMedicare PIN