Healthcare Provider Details

I. General information

NPI: 1437780806
Provider Name (Legal Business Name): ISHMAEL CHRISTIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6961 UNIVERSITY BLVD
WINTER PARK FL
32792-6710
US

IV. Provider business mailing address

5540 LESSER DR
ORLANDO FL
32818-1246
US

V. Phone/Fax

Practice location:
  • Phone: 407-543-8356
  • Fax:
Mailing address:
  • Phone: 407-613-7361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: