Provider Demographics
NPI:1710766506
Name:BEATO, ERNIS Y
Entity Type:Individual
Prefix:
First Name:ERNIS
Middle Name:Y
Last Name:BEATO
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 1:4733 W WATERS AVE APT 827
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1455
Mailing Address - Country:US
Mailing Address - Phone:813-834-0395
Mailing Address - Fax:
Practice Address - Street 1:4733 W WATERS AVE APT 827
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1455
Practice Address - Country:US
Practice Address - Phone:813-834-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB355219892700172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty