Healthcare Provider Details

I. General information

NPI: 1679938823
Provider Name (Legal Business Name): AVENTUS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 CORPORATE BLVD STE 315
ORLANDO FL
32817
US

IV. Provider business mailing address

11301 CORPORATE BLVD STE 315
ORLANDO FL
32817-8370
US

V. Phone/Fax

Practice location:
  • Phone: 321-356-1454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: NAGI YOUSSEF
Title or Position: PRESIDENT
Credential:
Phone: 321-356-1454