Healthcare Provider Details

I. General information

NPI: 1609191956
Provider Name (Legal Business Name): CENTRAL FLORIDA GERIATRIC PSYCHIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W COLONIAL DR SUITE 302
ORLANDO FL
32804-6863
US

IV. Provider business mailing address

PO BOX 940578
MAITLAND FL
32794-0578
US

V. Phone/Fax

Practice location:
  • Phone: 407-362-5459
  • Fax: 407-362-5472
Mailing address:
  • Phone: 407-362-5459
  • Fax: 407-386-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LUIS ALLEN
Title or Position: PRESIDENT
Credential: MD
Phone: 407-362-5459