Provider Demographics
NPI:1851359301
Name:ORBEGOZO, MAURICIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:
Last Name:ORBEGOZO
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 1:4730 N HABANA AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7163
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-864-4436
Practice Address - Street 1:4730 N HABANA AVE
Practice Address - Street 2:STE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7163
Practice Address - Country:US
Practice Address - Phone:844-542-5724
Practice Address - Fax:813-864-4436
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-057562207L00000X, 207LP2900X
FLME127833207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36097219Medicaid
IL36097219Medicaid