Healthcare Provider Details

I. General information

NPI: 1255149209
Provider Name (Legal Business Name): NORMA M LORA TAVERAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 CONWAY RD
ORLANDO FL
32812-2202
US

IV. Provider business mailing address

7101 SW 77TH PL
MIAMI FL
33143-2721
US

V. Phone/Fax

Practice location:
  • Phone: 407-931-0444
  • Fax: 407-962-4446
Mailing address:
  • Phone: 786-417-8663
  • Fax: 407-962-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: