Healthcare Provider Details

I. General information

NPI: 1942135736
Provider Name (Legal Business Name): LONGEVITY HEALTH OF WINTER PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 ALOMA AVE STE 124
WINTER PARK FL
32792-2541
US

IV. Provider business mailing address

2431 ALOMA AVE STE 124
WINTER PARK FL
32792-2541
US

V. Phone/Fax

Practice location:
  • Phone: 407-308-2125
  • Fax:
Mailing address:
  • Phone: 407-308-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARMEN RODRIGUEZ
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 832-434-9975