Healthcare Provider Details

I. General information

NPI: 1386675205
Provider Name (Legal Business Name): MYRTHO M BRANCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYRTHO MOMPOINT-BRANCH MD

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 DISCOVERY DR
ORLANDO FL
32826-3709
US

IV. Provider business mailing address

2500 DISCOVERY DR
ORLANDO FL
32826-3709
US

V. Phone/Fax

Practice location:
  • Phone: 407-275-2203
  • Fax: 407-282-7012
Mailing address:
  • Phone: 407-275-2203
  • Fax: 407-282-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME73432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: