Provider Demographics
NPI:1972537587
Name:ORJUELA, NUBIA
Entity Type:Individual
Prefix:
First Name:NUBIA
Middle Name:
Last Name:ORJUELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10739 TAVISTOCK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1718
Mailing Address - Country:US
Mailing Address - Phone:813-417-5888
Mailing Address - Fax:
Practice Address - Street 1:13904 GLOVER PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3126
Practice Address - Country:US
Practice Address - Phone:813-417-5888
Practice Address - Fax:813-962-8350
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0208X
FLME 66670246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3741Medicare ID - Type Unspecified