Healthcare Provider Details

I. General information

NPI: 1194845628
Provider Name (Legal Business Name): MARIA MINAMAHAL PATINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 03/07/2023
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

8217 MARBELLA VIEW CT
ORLANDO FL
32817-1560
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number57-009901
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127722
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number047172
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: