Provider Demographics
NPI:1649888769
Name:IPARRAGUIRRE GONGORA, ORIBERTO (NP)
Entity type:Individual
Prefix:
First Name:ORIBERTO
Middle Name:
Last Name:IPARRAGUIRRE GONGORA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 BARKFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7121
Mailing Address - Country:US
Mailing Address - Phone:786-316-2721
Mailing Address - Fax:
Practice Address - Street 1:623 BARKFIELD LOOP
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7121
Practice Address - Country:US
Practice Address - Phone:786-316-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily