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General NPI Number Information
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NPI Number | 1144526385
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Entity Type | Organization
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Legal Business Name | HEREDIA HEALTH CLINIC INC
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Dates
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Enumeration Date | 02/06/2011
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Last Update Date | 02/06/2011
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Provider Practice Location Address
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Address Line | 6052 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32809-4283
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Country | US
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Telephone | 407-240-9500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2358
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City | WINDERMERE
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State | FL
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Zip | 34786-2358
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Country | US
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Telephone | 407-240-9500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE REINALDO HEREDIA
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Credential | D.C.
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Telephone | 407-240-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CH 7044
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License Number State | FL
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