=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033742317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA MAJESTY HEALTH CARE LLC2
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2020
-----------------------------------------------------
Last Update Date | 02/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1805 W COLONIAL DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-7011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-350-4840
-----------------------------------------------------
Fax | 407-350-5806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1674 PLEASANT HILL RD
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34746-3954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-350-4840
-----------------------------------------------------
Fax | 407-350-5806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. WILLY NOEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-461-5981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------