Healthcare Provider Details

I. General information

NPI: 1609894237
Provider Name (Legal Business Name): MARIA DE LOS ANGELES GARCIA HERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 VINELAND RD STE 209
ORLANDO FL
32819-7855
US

IV. Provider business mailing address

121 S ORANGE AVE STE 940
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 407-627-0066
  • Fax: 407-440-4054
Mailing address:
  • Phone: 407-658-9687
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: