1689048472 NPI number — ORLANDO HEALTH AGENT FOR OHPG, INC.

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 1689048472 NPI number — ORLANDO HEALTH AGENT FOR OHPG, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLANDO HEALTH AGENT FOR OHPG, INC.
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:
1689048472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2015
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 282
Provider Business Mailing Address City Name:
OCOEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34761-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-351-5384
Provider Business Mailing Address Fax Number:

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 282
Provider Business Practice Location Address City Name:
OCOEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34761-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-351-5384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
407-351-5384

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com