Healthcare Provider Details

I. General information

NPI: 1508971698
Provider Name (Legal Business Name): MARIA ELENA DUMALAOG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA ELENA DUMALAOG-WATSON

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MILLS AVE
ORLANDO FL
32803-5722
US

IV. Provider business mailing address

414 N MILLS AVE
ORLANDO FL
32803-5722
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-7290
  • Fax: 407-636-7800
Mailing address:
  • Phone: 407-841-7290
  • Fax: 407-636-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77853
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME77853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: