Healthcare Provider Details

I. General information

NPI: 1104839497
Provider Name (Legal Business Name): CARLOS E SABOGAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W GORE STREET
ORLANDO FL
32806-1101
US

IV. Provider business mailing address

60 W GORE STREET
ORLANDO FL
32806-1101
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-5384
  • Fax: 407-445-0321
Mailing address:
  • Phone: 407-351-5384
  • Fax: 407-445-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0071023
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME71023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: