1003017435 NPI number — WEST ORANGE HEALTHCARE DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003017435 NPI number — WEST ORANGE HEALTHCARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST ORANGE HEALTHCARE DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003017435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10000 W COLONIAL DR
Provider Second Line Business Mailing Address:
STE 387
Provider Business Mailing Address City Name:
OCOEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34761-3498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-578-0033
Provider Business Mailing Address Fax Number:
407-294-8003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 W COLONIAL DR
Provider Second Line Business Practice Location Address:
STE 387
Provider Business Practice Location Address City Name:
OCOEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34761-3498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-578-0033
Provider Business Practice Location Address Fax Number:
407-294-8003
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIEGUEZ
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
MIQUEL
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
407-578-0033

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 069787700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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