Healthcare Provider Details

I. General information

NPI: 1609059245
Provider Name (Legal Business Name): HERON DACIA CAGLIN MED, EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 BROKEN OAK DR
WINTER GARDEN FL
34787-4270
US

IV. Provider business mailing address

1408 BROKEN OAK DR
WINTER GARDEN FL
34787-4270
US

V. Phone/Fax

Practice location:
  • Phone: 407-446-0480
  • Fax:
Mailing address:
  • Phone: 407-446-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 2137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: