Healthcare Provider Details

I. General information

NPI: 1568162741
Provider Name (Legal Business Name): HORIZON WEST PEDIATRICS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 HAMLIN GROVES TRAIL
WINTER GARDEN FL
34787
US

IV. Provider business mailing address

5382 BOWMAN DR
WINTER GARDEN FL
34787-5022
US

V. Phone/Fax

Practice location:
  • Phone: 407-848-9394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HUMBERTO LIRIANO
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 407-848-9394