Healthcare Provider Details

I. General information

NPI: 1700871795
Provider Name (Legal Business Name): WATERFORD LAKES WOMEN'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11399 LAKE UNDERHILL RD
ORLANDO FL
32825-5023
US

IV. Provider business mailing address

11399 LAKE UNDERHILL RD
ORLANDO FL
32825-5023
US

V. Phone/Fax

Practice location:
  • Phone: 407-207-6768
  • Fax: 407-249-5025
Mailing address:
  • Phone: 407-207-6768
  • Fax: 407-249-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. FERNANDO LOPEZ
Title or Position: OWNER
Credential: M.D.
Phone: 407-207-6768