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14065 Town Loop Blvd Ste 300 Orlando FL 32837-6199 | |
| (407) 735-2114 | |
| (407) 735-2119 |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 14065 Town Loop Blvd Ste 300, Orlando, Florida |
| Authorized Official Name and Position | Mariahelena Martinez (COO) |
| Authorized Official Contact | 3522428779 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8000 Sw 117th Ave Ste 205 Miami FL 33183-4809 Ph: (305) 273-9100 | 14065 Town Loop Blvd Ste 300 Orlando FL 32837-6199 Ph: (407) 735-2114 |
| NPI Number | 1063067643 |
|---|---|
| Provider Enumeration Date | 08/09/2019 |
| Last Update Date | 01/08/2025 |
| Medicare PECOS PAC ID | 5991135287 |
|---|---|
| Medicare Enrollment ID | O20200429002006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063067643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Ralph Rosario-medina |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1326084674 PECOS PAC ID: 0345222956 Enrollment ID: I20040607000086 |
| Provider Name | Leoncio Yang Laroco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720682107 PECOS PAC ID: 3971901273 Enrollment ID: I20220819001954 |
| Provider Name | Neil Natkow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275989378 PECOS PAC ID: 6002107455 Enrollment ID: I20220901002257 |
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