Healthcare Provider Details

I. General information

NPI: 1124107255
Provider Name (Legal Business Name): FRANCISCO RAFAEL OQUENDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 S SEMORAN BLVD SUITE E
ORLANDO FL
32807-1459
US

IV. Provider business mailing address

1140 S SEMORAN BLVD SUITE E
ORLANDO FL
32807-1459
US

V. Phone/Fax

Practice location:
  • Phone: 407-384-9165
  • Fax: 407-384-9174
Mailing address:
  • Phone: 407-384-9165
  • Fax: 407-384-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15967
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberACN598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: