Healthcare Provider Details

I. General information

NPI: 1376074146
Provider Name (Legal Business Name): INFECTIOUS DISEASE CARE OF CENTRAL FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
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
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 Code405300000X
TaxonomyPrevention Professional
License NumberME30833
License Number StateFL

VIII. Authorized Official

Name: PROF. PHILLIP L SANCHEZ
Title or Position: OWNER/ PRESIDENT
Credential: M.D
Phone: 407-644-9002