| Mydr Family Clinic, Pa | |
|
1952 N John Young Pkwy Kissimmee FL 34741-3221 | |
| (407) 978-6605 | |
| (407) 978-6610 |
| Full Name | Mydr Family Clinic, Pa |
|---|---|
| Speciality | General Practice |
| Location | 1952 N John Young Pkwy, Kissimmee, Florida |
| Authorized Official Name and Position | Caridad Gonzalez (OWNER) |
| Authorized Official Contact | 4079786605 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mydr Family Clinic, Pa 1962 N John Young Pkwy Kissimmee FL 34741-3221 Ph: (407) 978-6605 | Mydr Family Clinic, Pa 1952 N John Young Pkwy Kissimmee FL 34741-3221 Ph: (407) 978-6605 |
| NPI Number | 1619504479 |
|---|---|
| Provider Enumeration Date | 03/23/2020 |
| Last Update Date | 05/24/2021 |
| Medicare PECOS PAC ID | 1850716473 |
|---|---|
| Medicare Enrollment ID | O20200730000147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619504479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Caridad Gonzalez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1033489042 PECOS PAC ID: 3971763350 Enrollment ID: I20171130003277 |
| Provider Name | Raydelys Camejo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972120376 PECOS PAC ID: 2668764101 Enrollment ID: I20200903002552 |
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