Healthcare Provider Details

I. General information

NPI: 1982691754
Provider Name (Legal Business Name): ANGELA M FALS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 LEE RD STE 307
WINTER PARK FL
32789-2101
US

IV. Provider business mailing address

1801 LEE RD STE 307
WINTER PARK FL
32789-2101
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-9200
  • Fax: 407-303-9201
Mailing address:
  • Phone: 407-303-9200
  • Fax: 407-303-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME81834
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License NumberME81834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: