Healthcare Provider Details

I. General information

NPI: 1811790660
Provider Name (Legal Business Name): FWC PERINATAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6427 WESTWOOD BLVD UNIT 100
ORLANDO FL
32821-8311
US

IV. Provider business mailing address

PO BOX 81798
CLEVELAND OH
44181-0798
US

V. Phone/Fax

Practice location:
  • Phone: 321-566-2829
  • Fax: 321-566-2839
Mailing address:
  • Phone: 561-300-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA HERNANDEZ
Title or Position: DIRECTOR
Credential:
Phone: 561-300-2410