Healthcare Provider Details

I. General information

NPI: 1972123701
Provider Name (Legal Business Name): HEART CLINIC OF CENTRAL FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 RILEY RD # 429
CELEBRATION FL
34747-5420
US

IV. Provider business mailing address

119 CELEBRATION BLVD
KISSIMMEE FL
34747-5009
US

V. Phone/Fax

Practice location:
  • Phone: 407-913-6602
  • Fax: 201-419-2656
Mailing address:
  • Phone: 407-913-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAGDA E SANCHEZ-VELEZ
Title or Position: MBR
Credential: MD
Phone: 407-913-6602