Healthcare Provider Details

I. General information

NPI: 1518268283
Provider Name (Legal Business Name): WALK IN MEDICAL CLINIC AND FITNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 INNOVATION DR STE A
SAINT CLOUD FL
34769-6501
US

IV. Provider business mailing address

3105 INNOVATION DR STE A
SAINT CLOUD FL
34769-6501
US

V. Phone/Fax

Practice location:
  • Phone: 407-498-0539
  • Fax: 877-203-2038
Mailing address:
  • Phone: 407-498-0539
  • Fax: 877-203-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number105419
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD037726L
License Number StatePA

VIII. Authorized Official

Name: DR. NICANOR C. LOPEZ
Title or Position: OWNER
Credential: M.D.
Phone: 267-475-8447