1790802395 NPI number — ORLANDO CARDIOVASCULAR INSTITUTE P A

Table of content: JENNA RADOWSKI MS ATR LCPC (NPI 1437549110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790802395 NPI number — ORLANDO CARDIOVASCULAR INSTITUTE P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLANDO CARDIOVASCULAR INSTITUTE P A
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:
1790802395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32802-3749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-228-7373
Provider Business Mailing Address Fax Number:
407-228-7393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 N ORANGE AVE
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32804-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-228-7373
Provider Business Practice Location Address Fax Number:
407-228-7393
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARMONA-TORRES
Authorized Official First Name:
MARISEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
407-228-7373

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  ME62668 , 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)





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