Healthcare Provider Details

I. General information

NPI: 1295990497
Provider Name (Legal Business Name): CENTRAL FLORIDA INFECTIOUS DISEASES GROUP PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 GROVELAND ST
ORLANDO FL
32804-4019
US

IV. Provider business mailing address

316 GROVELAND ST
ORLANDO FL
32804-4019
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-9660
  • Fax: 407-896-9661
Mailing address:
  • Phone: 407-896-9660
  • Fax: 407-896-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERYL PACHA
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-896-9660