Healthcare Provider Details

I. General information

NPI: 1679341291
Provider Name (Legal Business Name): LUIS DAVID COBAS AMADOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 LAKE LUCIEN DR STE 112
MAITLAND FL
32751-7233
US

IV. Provider business mailing address

PO BOX 40549
BELFAST ME
04915-1256
US

V. Phone/Fax

Practice location:
  • Phone: 321-207-9029
  • Fax:
Mailing address:
  • Phone: 321-207-9029
  • Fax: 844-410-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11030142
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11030142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: