Healthcare Provider Details

I. General information

NPI: 1700392172
Provider Name (Legal Business Name): MARIA DEL CARMEN FREIRE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA DEL CARMEN MANDRY

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CITRUS MEDICAL CT
OCOEE FL
34761-4547
US

IV. Provider business mailing address

10325 BIRCH TREE LN
WINDERMERE FL
34786-8021
US

V. Phone/Fax

Practice location:
  • Phone: 407-480-4830
  • Fax: 407-480-4834
Mailing address:
  • Phone: 407-951-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: