Healthcare Provider Details

I. General information

NPI: 1518173293
Provider Name (Legal Business Name): ADVANCED BODY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 S JOHN YOUNG PKWY SUITE 107
ORLANDO FL
32837-3420
US

IV. Provider business mailing address

12701 S JOHN YOUNG PKWY SUITE 107
ORLANDO FL
32837-3420
US

V. Phone/Fax

Practice location:
  • Phone: 407-856-0076
  • Fax: 407-856-0751
Mailing address:
  • Phone: 407-856-0076
  • Fax: 407-856-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. OSWALDO PEREZ
Title or Position: CEO
Credential:
Phone: 407-856-0076