1487733424 NPI number — PSYCHIATRIC SVCS OF WINTER PAR

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 1487733424 NPI number — PSYCHIATRIC SVCS OF WINTER PAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRIC SVCS OF WINTER PAR
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:
1487733424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2252 WINTER WOODS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-1957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-681-6003
Provider Business Mailing Address Fax Number:
407-681-6006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2252 WINTER WOODS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32792-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-681-6003
Provider Business Practice Location Address Fax Number:
407-681-6006
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUINONES
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
ENRIQUE
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
407-681-6003

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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