Healthcare Provider Details

I. General information

NPI: 1417209511
Provider Name (Legal Business Name): IRES GALLO ELOMINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRIS G BUCKLEY

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 GARDEN PLAZA
ORLANDO FL
32803-1111
US

IV. Provider business mailing address

718 GARDEN PLAZA
ORLANDO FL
32803-1111
US

V. Phone/Fax

Practice location:
  • Phone: 407-488-3557
  • Fax: 407-894-8893
Mailing address:
  • Phone: 407-488-3557
  • Fax: 407-894-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: