Healthcare Provider Details

I. General information

NPI: 1134533136
Provider Name (Legal Business Name): WOMENS HEALTH AND SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N SEMORAN BLVD SUITE 205
WINTER PARK FL
32792-3800
US

IV. Provider business mailing address

483 N SEMORAN BLVD SUITE 204
WINTER PARK FL
32792-3800
US

V. Phone/Fax

Practice location:
  • Phone: 497-215-6321
  • Fax:
Mailing address:
  • Phone: 407-215-6321
  • Fax: 321-274-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: IVAN MARTINEZ
Title or Position: CONTROLLER
Credential:
Phone: 407-215-6321