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General NPI Number Information
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NPI Number | 1285070193
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Entity Type | Organization
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Legal Business Name | PEDIATRICS OF GREATER ORLANDO
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Dates
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Enumeration Date | 05/18/2013
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Last Update Date | 05/18/2013
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Provider Practice Location Address
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Address Line | 1515 PARK CENTER DR SUITE D
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City | ORLANDO
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State | FL
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Zip | 32835-5794
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Country | US
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Telephone | 407-716-4592
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 WESTOVER RESERVE BLVD
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City | WINDERMERE
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State | FL
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Zip | 34786-6213
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Country | US
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Telephone | 407-716-4592
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HERNANDO ALEXANDER CARDONA
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Credential | MD
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Telephone | 407-716-4592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME88235
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License Number State | FL
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