Healthcare Provider Details

I. General information

NPI: 1790704906
Provider Name (Legal Business Name): ECG READING PANEL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 KUHL AVE
ORLANDO FL
32806-2008
US

IV. Provider business mailing address

PO BOX 144333
ORLANDO FL
32814-4333
US

V. Phone/Fax

Practice location:
  • Phone: 407-422-9831
  • Fax: 407-648-2065
Mailing address:
  • Phone: 407-422-9831
  • Fax: 407-648-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ERNESTO FERNANDEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-422-9831