Healthcare Provider Details

I. General information

NPI: 1174583579
Provider Name (Legal Business Name): EDGAR A ORELLANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDGAR G ORELLANA MD

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S W C OWENS AVE
CLEWISTON FL
33440-3637
US

IV. Provider business mailing address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

V. Phone/Fax

Practice location:
  • Phone: 863-983-7813
  • Fax: 863-983-9604
Mailing address:
  • Phone: 561-844-9443
  • Fax: 561-472-9692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME62808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: