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General NPI Number Information
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NPI Number | 1194214684
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Entity Type | Organization
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Legal Business Name | ADVANCE OBGYN OF CENTRAL FLORIDA
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 4170 TOWN CTR BLVD STE 104
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City | ORLANDO
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State | FL
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Zip | 32837
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Country | US
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Telephone | 407-451-8443
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Fax |
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Provider Business Mailing Address
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Address Line | 6441 S CHICKASAW TRL # 216
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City | ORLANDO
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State | FL
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Zip | 32829-8366
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Country | US
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Telephone | 407-776-8410
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CHRISTIE GONZALEZ
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Credential |
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Telephone | 407-776-8410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME131939
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License Number State | FL
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