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General NPI Number Information
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NPI Number | 1255856589
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Entity Type | Organization
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Legal Business Name | ORLANDO CENTER FOR ADVANCED PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 04/24/2021
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Provider Practice Location Address
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Address Line | 4106 W LAKE MARY BLVD STE 212
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City | LAKE MARY
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State | FL
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Zip | 32746-3344
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Country | US
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Telephone | 407-333-2525
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Fax | 407-333-9583
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Provider Business Mailing Address
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Address Line | 4106 W LAKE MARY BLVD STE 212
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City | LAKE MARY
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State | FL
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Zip | 32746-3344
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Country | US
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Telephone | 407-333-2525
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Fax | 407-333-9583
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Authorized Official
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Title or Position | DIRECTOR
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Name | EDGAR SOSA
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Credential | DO
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Telephone | 407-333-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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