Provider Demographics
NPI:1366252371
Name:PARDO, ALEJANDRO JESUS
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:JESUS
Last Name:PARDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11715 SW 18TH ST APT 509
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1693
Mailing Address - Country:US
Mailing Address - Phone:786-707-7913
Mailing Address - Fax:
Practice Address - Street 1:2111 S OLD MISSOURI RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-8718
Practice Address - Country:US
Practice Address - Phone:479-340-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program