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1459 Lake Baldwin Ln Suite A Orlando FL 32814-6741 | |
| (407) 893-3905 | |
| (407) 893-3906 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 1459 Lake Baldwin Ln, Orlando, Florida |
| Authorized Official Name and Position | S Rafik Bouaziz (MANAGER / DIRECTOR) |
| Authorized Official Contact | 4078933905 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 149374 Orlando FL 32814-9374 Ph: (407) 893-3905 | 1459 Lake Baldwin Ln Suite A Orlando FL 32814-6741 Ph: (407) 893-3905 |
| NPI Number | 1619132867 |
|---|---|
| Provider Enumeration Date | 07/26/2008 |
| Last Update Date | 03/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619132867 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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