Healthcare Provider Details

I. General information

NPI: 1679299028
Provider Name (Legal Business Name): TELOS HEALTH AND PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3154 S ORANGE AVE STE 200
ORLANDO FL
32806-6122
US

IV. Provider business mailing address

420 E CHURCH ST UNIT 614
ORLANDO FL
32801-2789
US

V. Phone/Fax

Practice location:
  • Phone: 321-300-3113
  • Fax:
Mailing address:
  • Phone: 817-706-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL SOTO-GARCIA
Title or Position: OWNER
Credential: DC
Phone: 817-706-1194