Healthcare Provider Details

I. General information

NPI: 1992004576
Provider Name (Legal Business Name): NORBERTO GARCIA-HENRIQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 S CHICKASAW TRL STE 201
ORLANDO FL
32825-3523
US

IV. Provider business mailing address

258 S CHICKASAW TRL STE 201
ORLANDO FL
32825-3523
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6626
  • Fax: 407-303-6634
Mailing address:
  • Phone: 407-303-6626
  • Fax: 407-303-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME138022
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME138022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: