Healthcare Provider Details

I. General information

NPI: 1295308385
Provider Name (Legal Business Name): CENTRAL FLORIDA PEDIATRIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

12386 STATE ROAD 535 # 422
ORLANDO FL
32836-6701
US

V. Phone/Fax

Practice location:
  • Phone: 352-328-6127
  • Fax:
Mailing address:
  • Phone: 352-328-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FARIS MAHMOUD AL-MOUSILY
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 352-328-6127