Healthcare Provider Details

I. General information

NPI: 1386362218
Provider Name (Legal Business Name): CHALDEAN-CARE INFECTIOUS DISEASES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 29TH ST
ORLANDO FL
32805-6219
US

IV. Provider business mailing address

4300 W LAKE MARY BLVD STE 1010 PMB 135
LAKE MARY FL
32746-2449
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-8905
  • Fax: 312-972-8945
Mailing address:
  • Phone: 321-972-8905
  • Fax: 312-972-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE C VANHORNE-PADILLA
Title or Position: OWNER
Credential: MD
Phone: 956-655-3078