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92 N Dean Rd Ste 100 Orlando FL 32825-3769 | |
| (407) 916-0304 | |
| (888) 960-6364 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 92 N Dean Rd Ste 100, Orlando, Florida |
| Authorized Official Name and Position | Ramon Luis Rodriguez-cruz (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4079160304 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11954 Narcoossee Rd #2 Suite 150 Orlando FL 32832 Ph: (407) 916-0304 | 92 N Dean Rd Ste 100 Orlando FL 32825-3769 Ph: (407) 916-0304 |
| NPI Number | 1962987610 |
|---|---|
| Provider Enumeration Date | 09/28/2018 |
| Last Update Date | 09/03/2024 |
| Certification Date | 09/03/2024 |
| Medicare PECOS PAC ID | 2163760117 |
|---|---|
| Medicare Enrollment ID | O20190218000070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962987610 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Ramon L Rodriguez Cruz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1255377099 PECOS PAC ID: 9931138039 Enrollment ID: I20050809000772 |
| Provider Name | Railet Barbara Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104374164 PECOS PAC ID: 3072894070 Enrollment ID: I20170106000266 |
| Provider Name | Michael Lagoe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730698044 PECOS PAC ID: 3173884780 Enrollment ID: I20180222001420 |
| Provider Name | Lourdes M Benes |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1710170592 PECOS PAC ID: 6204996630 Enrollment ID: I20190408001622 |
| Provider Name | Grace Nicole Thayer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255051033 PECOS PAC ID: 4587032388 Enrollment ID: I20221129002372 |
| Provider Name | Maria Artiles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124860465 PECOS PAC ID: 2961935192 Enrollment ID: I20241028000336 |
| Provider Name | Maria Torres |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790541324 PECOS PAC ID: 1658804802 Enrollment ID: I20241028001350 |
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