Healthcare Provider Details

I. General information

NPI: 1417622648
Provider Name (Legal Business Name): URBAN HEALTH PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 W HWY 50
CLERMONT FL
34711-3027
US

IV. Provider business mailing address

265 W HWY 50
CLERMONT FL
34711-3027
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-5535
  • Fax: 352-394-5810
Mailing address:
  • Phone: 352-394-5535
  • Fax: 352-394-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DWIGHT PEREZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 305-733-5713