Healthcare Provider Details

I. General information

NPI: 1912007485
Provider Name (Legal Business Name): LIDIA FLORES OLIVEIRA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 RINEHART RD
LAKE MARY FL
32746-4802
US

IV. Provider business mailing address

PO BOX 22795
ORLANDO FL
32830-2795
US

V. Phone/Fax

Practice location:
  • Phone: 407-248-9003
  • Fax: 407-248-0445
Mailing address:
  • Phone: 407-248-9003
  • Fax: 407-248-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS6402
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS6402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: