Healthcare Provider Details

I. General information

NPI: 1720078553
Provider Name (Legal Business Name): CARMELITA BAMBA DAGANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 N MILLS AVE
ORLANDO FL
32803-1853
US

IV. Provider business mailing address

500 N JOHN YOUNG PKWY
KISSIMMEE FL
34741-4906
US

V. Phone/Fax

Practice location:
  • Phone: 407-206-2375
  • Fax: 407-206-2377
Mailing address:
  • Phone: 407-935-1060
  • Fax: 407-933-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME33174
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: