Provider Demographics
NPI:1316957111
Name:FLORENDO, FEDERICO T (MD)
Entity type:Individual
Prefix:MR
First Name:FEDERICO
Middle Name:T
Last Name:FLORENDO
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 1:13188 N 103RD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3066
Mailing Address - Country:US
Mailing Address - Phone:623-875-6001
Mailing Address - Fax:623-875-8761
Practice Address - Street 1:13188 N 103RD DR STE 200
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3066
Practice Address - Country:US
Practice Address - Phone:623-875-6001
Practice Address - Fax:623-875-8761
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD12688208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC99485Medicare UPIN
AZZ24553Medicare ID - Type UnspecifiedMEDICARE