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General NPI Number Information
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NPI Number | 1255888160
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Entity Type | Organization
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Legal Business Name | MY FAMILY MEDICAL GROUP LLC
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 4311 ANDERSON RD
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City | ORLANDO
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State | FL
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Zip | 32812-7358
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Country | US
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Telephone | 787-433-0055
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Fax | 787-931-7755
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Provider Business Mailing Address
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Address Line | 4311 ANDERSON RD
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City | ORLANDO
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State | FL
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Zip | 32812-7358
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Country | US
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Telephone | 787-433-0055
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Fax | 787-931-7755
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Authorized Official
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Title or Position | CEO
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Name | DR. CARLOS R CARDONA
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Credential | M. D.
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Telephone | 787-433-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | ACN804
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License Number State | FL
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