Healthcare Provider Details

I. General information

NPI: 1881499861
Provider Name (Legal Business Name): ACCESS MEDICAL GROUP OF SAND LAKE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 WEST SAND LAKE RD STE 8
ORLANDO FL
32809-7084
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 407-232-6160
  • Fax: 407-220-1975
Mailing address:
  • Phone: 786-322-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAYNY RAMIREZ
Title or Position: CEO
Credential:
Phone: 786-322-7333