Healthcare Provider Details

I. General information

NPI: 1700273000
Provider Name (Legal Business Name): HOME PHYSICIANS GROUP P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 N ALAFAYA TRL STE A
ORLANDO FL
32826-4743
US

IV. Provider business mailing address

1834 N ALAFAYA TRL SUITE A
ORLANDO FL
32826-4743
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-0694
  • Fax: 321-235-0694
Mailing address:
  • Phone: 321-235-0692
  • Fax: 321-235-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS7691
License Number StateFL

VIII. Authorized Official

Name: GABRIEL NURIEL
Title or Position: CEO
Credential: D.O.
Phone: 407-590-6399