Healthcare Provider Details

I. General information

NPI: 1932217288
Provider Name (Legal Business Name): INFECTIOUS DISEASES ORLANDO PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 05/13/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9624 BLACK BEAR LN
WINTER GARDEN FL
34787
US

IV. Provider business mailing address

PO BOX 98
WINDERMERE FL
34786-0098
US

V. Phone/Fax

Practice location:
  • Phone: 407-719-2629
  • Fax: 407-992-9441
Mailing address:
  • Phone: 407-719-2629
  • Fax: 407-622-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN C TORRES
Title or Position: PRESIDENT
Credential: MD
Phone: 407-622-5008