Healthcare Provider Details

I. General information

NPI: 1699893701
Provider Name (Legal Business Name): CENTRAL FLORIDA PRIMARY CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 S SEMORAN BLVD
ORLANDO FL
32807-3293
US

IV. Provider business mailing address

172 S SEMORAN BLVD
ORLANDO FL
32807-3293
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-1951
  • Fax: 407-380-1343
Mailing address:
  • Phone: 407-380-1951
  • Fax: 407-380-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: FLORENCIO ELLO
Title or Position: PRESIDENT
Credential: MD
Phone: 407-380-1951