Healthcare Provider Details

I. General information

NPI: 1891113809
Provider Name (Legal Business Name): ORVILLE MARIO MORGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 EVANGELINE AVE.
ORLANDO FL
32809
US

IV. Provider business mailing address

1220 EVANGELINE AVE
ORLANDO FL
32809-7034
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-2210
  • Fax:
Mailing address:
  • Phone: 407-857-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: