Healthcare Provider Details

I. General information

NPI: 1952074346
Provider Name (Legal Business Name): ANGELS ON EARTH PPEC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 US HIGHWAY 98 N
LAKELAND FL
33809-2100
US

IV. Provider business mailing address

12200 MENTA ST STE 105
ORLANDO FL
32837-7540
US

V. Phone/Fax

Practice location:
  • Phone: 407-757-2257
  • Fax:
Mailing address:
  • Phone: 407-757-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: ALEIDA CABRERA
Title or Position: PRESIDENT
Credential:
Phone: 407-757-2257