Healthcare Provider Details

I. General information

NPI: 1033553557
Provider Name (Legal Business Name): PRESTIGE ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 W FAIRBANKS AVE SUITE 350
WINTER PARK FL
32789-7111
US

IV. Provider business mailing address

1245 W FAIRBANKS AVE SUITE 350
WINTER PARK FL
32789-7111
US

V. Phone/Fax

Practice location:
  • Phone: 877-941-0111
  • Fax: 954-785-1191
Mailing address:
  • Phone: 877-941-0111
  • Fax: 954-785-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: CINTIA MUNOZ
Title or Position: BILLING MANAGER
Credential:
Phone: 561-686-6201