Healthcare Provider Details

I. General information

NPI: 1992752372
Provider Name (Legal Business Name): REGINO P. GONZALEZ PERALTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: REGINO P GONZALEZ PERALTA

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 401
ORLANDO FL
32803-1469
US

IV. Provider business mailing address

615 E PRINCETON ST STE 401
ORLANDO FL
32803-1469
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-9311
  • Fax: 407-303-9273
Mailing address:
  • Phone: 407-303-9311
  • Fax: 407-303-9273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME56890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: