Basic Information
| Provider Information | |||||||||
| NPI: | 1811218613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASSABOV | ||||||||
| FirstName: | DANIELA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DRAGANOVA | ||||||||
| OtherFirstName: | DANIELA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 850001 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328850001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417472090 | ||||||||
| FaxNumber: | 9415567785 | ||||||||
| Practice Location | |||||||||
| Address1: | 11505 PALMBRUSH TRL | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342022915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417472090 | ||||||||
| FaxNumber: | 9415567785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2010 | ||||||||
| LastUpdateDate: | 08/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11015346A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME116023 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.