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701 E Sr 50 Ste 731c Clermont FL 34711-3165 | |
| (321) 235-6230 | |
| (321) 235-6246 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 701 E Sr 50 Ste 731c, Clermont, Florida |
| Authorized Official Name and Position | Milady Reyes (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 3212356230 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5564 E Grant St Orlando FL 32822-1666 Ph: (321) 235-6230 | 701 E Sr 50 Ste 731c Clermont FL 34711-3165 Ph: (321) 235-6230 |
| NPI Number | 1134746878 |
|---|---|
| Provider Enumeration Date | 06/29/2020 |
| Last Update Date | 02/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134746878 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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