Healthcare Provider Details

I. General information

NPI: 1841288990
Provider Name (Legal Business Name): RITA T MAPA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA B TANCHULING MD

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 LAKE ELLENOR DR SUITE 105
ORLANDO FL
32809
US

IV. Provider business mailing address

4930 E LAKE MARY BLVD
SANFORD FL
32771-5003
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-8645
  • Fax: 407-956-4676
Mailing address:
  • Phone: 407-322-8645
  • Fax: 407-324-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: