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General NPI Number Information
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NPI Number | 1144020868
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Entity Type | Organization
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Legal Business Name | PENTUS HEALTH PRIMARY CARE
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 2273 LEE RD STE 201
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City | WINTER PARK
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State | FL
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Zip | 32789-7214
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Country | US
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Telephone | 538-559-6863
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Fax |
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Provider Business Mailing Address
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Address Line | 2273 LEE RD STE 201
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City | WINTER PARK
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State | FL
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Zip | 32789-7214
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Country | US
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Telephone | 407-756-3474
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. IVAN REYES
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Credential |
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Telephone | 538-559-6863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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