Healthcare Provider Details

I. General information

NPI: 1386034346
Provider Name (Legal Business Name): OHRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-4402
US

IV. Provider business mailing address

1414 KUHL AVE # MP212
ORLANDO FL
32806-2008
US

V. Phone/Fax

Practice location:
  • Phone: 407-331-3955
  • Fax: 407-331-9481
Mailing address:
  • Phone: 407-331-3955
  • Fax: 407-331-9481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: YESENIA GOMEZ MOSHER
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 321-842-3777