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General NPI Number Information
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NPI Number | 1295308385
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA PEDIATRIC
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 1222 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32806-1215
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Country | US
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Telephone | 352-328-6127
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Fax |
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Provider Business Mailing Address
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Address Line | 12386 STATE ROAD 535 # 422
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City | ORLANDO
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State | FL
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Zip | 32836-6701
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Country | US
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Telephone | 352-328-6127
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. FARIS MAHMOUD AL-MOUSILY
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Credential | MD
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Telephone | 352-328-6127
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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