1023384484 NPI number — CENTRAL FLORIDA OTOLARYNGOLOGY PLLC

Table of content: BLADIMIR SANCHEZ - PEREZ M.D. (NPI 1710270897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023384484 NPI number — CENTRAL FLORIDA OTOLARYNGOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL FLORIDA OTOLARYNGOLOGY PLLC
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:
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:
1023384484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 LIONEL WAY
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-225-6522
Provider Business Mailing Address Fax Number:
863-582-9796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 LIONEL WAY
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-225-6522
Provider Business Practice Location Address Fax Number:
863-582-9796
Provider Enumeration Date:
03/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
STUART
Authorized Official First Name:
MENACHEM
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
863-225-6522

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ME112526 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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