Healthcare Provider Details

I. General information

NPI: 1932240926
Provider Name (Legal Business Name): SERGIO W. LARACH, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

243 NOB HILL CIR
LONGWOOD FL
32779-4430
US

V. Phone/Fax

Practice location:
  • Phone: 407-797-5893
  • Fax: 407-884-5337
Mailing address:
  • Phone: 407-797-5893
  • Fax: 407-884-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SERGIO W LARACH
Title or Position: PRESIDENT
Credential: MD
Phone: 407-797-5893