Healthcare Provider Details

I. General information

NPI: 1427136399
Provider Name (Legal Business Name): INFECTIOUS DISEASE CARE OF CENTRAL FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N WYMORE RD SUITE 102
WINTER PARK FL
32789-2859
US

IV. Provider business mailing address

650 N WYMORE RD SUITE 102
WINTER PARK FL
32789-2859
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-9002
  • Fax: 407-644-9004
Mailing address:
  • Phone: 407-644-9002
  • Fax: 407-644-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP L SANCHEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 407-644-9002