| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 2714 Rew Cir, Ocoee, Florida |
| Authorized Official Name and Position | Jorge Enrique Monroy Avella (OWNER) |
| Authorized Official Contact | 4073885982 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2714 Rew Cir Ocoee FL 34761-2990 Ph: (407) 388-5982 | 2714 Rew Cir Ocoee FL 34761-2990 Ph: (407) 388-5982 |
| NPI Number | 1619672714 |
|---|---|
| Provider Enumeration Date | 03/30/2023 |
| Last Update Date | 11/10/2023 |
| Medicare PECOS PAC ID | 7113387325 |
|---|---|
| Medicare Enrollment ID | O20230720000082 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619672714 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Jorge E Monroy Avella |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1265860225 PECOS PAC ID: 2163747445 Enrollment ID: I20150209000006 |
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