Provider Demographics
NPI:1154525566
Name:PARDO-RUIZ, WANDALY IBON (MD)
Entity type:Individual
Prefix:DR
First Name:WANDALY
Middle Name:IBON
Last Name:PARDO-RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 PALLISTER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1950
Mailing Address - Country:US
Mailing Address - Phone:787-225-7213
Mailing Address - Fax:
Practice Address - Street 1:658 OVIEDO MEDICAL DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6574
Practice Address - Country:US
Practice Address - Phone:407-901-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18,117207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology