| Alina Community Center At Mount Dora Llc | |
|
4601 N Highway 19a Mount Dora FL 32757-2039 | |
| (352) 602-7924 | |
| (352) 602-4952 |
| Full Name | Alina Community Center At Mount Dora Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4601 N Highway 19a, Mount Dora, Florida |
| Authorized Official Name and Position | Gravil Joseph (MGR) |
| Authorized Official Contact | 3526027924 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alina Community Center At Mount Dora Llc 4601 N Highway 19a Mount Dora FL 32757-2039 Ph: (352) 602-7924 | Alina Community Center At Mount Dora Llc 4601 N Highway 19a Mount Dora FL 32757-2039 Ph: (352) 602-7924 |
| NPI Number | 1811550346 |
|---|---|
| Provider Enumeration Date | 04/19/2019 |
| Last Update Date | 01/02/2025 |
| Medicare PECOS PAC ID | 9032530829 |
|---|---|
| Medicare Enrollment ID | O20200603001057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811550346 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Joel C Pelissier |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1730454323 PECOS PAC ID: 5092961946 Enrollment ID: I20120808000365 |
| Provider Name | Gravil Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164960720 PECOS PAC ID: 3870860398 Enrollment ID: I20170603000156 |
| Provider Name | Khaled Ibrahim |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1497108393 PECOS PAC ID: 7113349663 Enrollment ID: I20200630000065 |
| Provider Name | Philippe Carrie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639431083 PECOS PAC ID: 7214175215 Enrollment ID: I20200714000714 |
| Provider Name | Scott Menard |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1417579244 PECOS PAC ID: 2567888944 Enrollment ID: I20200831002874 |
| Provider Name | Darmeta Bradley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750851044 PECOS PAC ID: 1951730563 Enrollment ID: I20230123000106 |
| Provider Name | Widdler Deshommes |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1376172015 PECOS PAC ID: 9739565169 Enrollment ID: I20240408001798 |
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