Healthcare Provider Details

I. General information

NPI: 1053649368
Provider Name (Legal Business Name): LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9580 W COLONIAL DR
OCOEE FL
34761-6947
US

IV. Provider business mailing address

9580 W COLONIAL DR
OCOEE FL
34761-6947
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-8848
  • Fax: 407-656-6901
Mailing address:
  • Phone: 407-656-8848
  • Fax: 407-656-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ARLENE GUZIK
Title or Position: VP OF OPERATIONS
Credential: DNP, ARNP-BC
Phone: 727-532-7644