Provider Demographics
NPI:1023732633
Name:ANA CONDE LLC
Entity type:Organization
Organization Name:ANA CONDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-368-3862
Mailing Address - Street 1:PO BOX 560538
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-0538
Mailing Address - Country:US
Mailing Address - Phone:321-368-3862
Mailing Address - Fax:
Practice Address - Street 1:2428 CLEARLAKE RD BLDG K
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-5722
Practice Address - Country:US
Practice Address - Phone:321-368-3862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty