Provider Demographics
NPI:1982631297
Name:NORONA, PABLO H (PSYD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:H
Last Name:NORONA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVE F NE
Mailing Address - Street 2:WINTER HAVEN HOSPITAL INC
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881
Mailing Address - Country:US
Mailing Address - Phone:863-293-1121
Mailing Address - Fax:863-291-6773
Practice Address - Street 1:200 AVE F NE
Practice Address - Street 2:WINTER HAVEN HOSPITAL INC
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881
Practice Address - Country:US
Practice Address - Phone:863-293-1121
Practice Address - Fax:863-291-6773
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8032Medicare ID - Type Unspecified