Healthcare Provider Details

I. General information

NPI: 1063434017
Provider Name (Legal Business Name): MEDICAL ALTERNATIVES OF AMERICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 VINELAND RD SUITE 209
ORLANDO FL
32819-7800
US

IV. Provider business mailing address

5979 VINELAND RD SUITE 209
ORLANDO FL
32819-7800
US

V. Phone/Fax

Practice location:
  • Phone: 407-352-1030
  • Fax: 407-352-2884
Mailing address:
  • Phone: 407-352-1030
  • Fax: 407-352-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP2617642
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103647
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME69749
License Number StateFL

VIII. Authorized Official

Name: JOSHUA MAYWALT
Title or Position: BILLING MANAGER
Credential:
Phone: 407-352-1030