Healthcare Provider Details

I. General information

NPI: 1114977329
Provider Name (Legal Business Name): FAMILY HEALTHCARE PLUS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W OAK ST SUITE 203
KISSIMMEE FL
34741-6614
US

IV. Provider business mailing address

801 W OAK ST SUITE 203
KISSIMMEE FL
34741-6614
US

V. Phone/Fax

Practice location:
  • Phone: 407-935-0566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberHCC6893
License Number StateFL

VIII. Authorized Official

Name: MR. RAMON CHANZA
Title or Position: PRESIDENT
Credential:
Phone: 407-935-0566