Healthcare Provider Details

I. General information

NPI: 1710588769
Provider Name (Legal Business Name): ELSY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GOLDEN SUNSHINE CIR
ORLANDO FL
32807-3456
US

IV. Provider business mailing address

600 GOLDEN SUNSHINE CIR
ORLANDO FL
32807-3456
US

V. Phone/Fax

Practice location:
  • Phone: 407-914-9530
  • Fax:
Mailing address:
  • Phone: 407-914-9530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ELOISA ALEXIS FARIAS RIOS
Title or Position: NEMT
Credential:
Phone: 407-914-9530