Healthcare Provider Details

I. General information

NPI: 1417518481
Provider Name (Legal Business Name): OHRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 WINTER GARDEN VINELAND ROAD., SUITE 104
WINDERMERE FL
34786
US

IV. Provider business mailing address

1414 KUHL AVE MP 162
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 407-637-8356
  • Fax:
Mailing address:
  • Phone: 321-841-8779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YESENIA GOMEZ MOSHER
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 321-842-3777