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General NPI Number Information
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NPI Number | 1306048343
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD PRIMARY CARE, P.A.
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 1170 S SEMORAN BLVD SUITE D
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City | ORLANDO
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State | FL
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Zip | 32807-1458
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Country | US
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Telephone | 407-282-4142
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Fax | 407-282-7475
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Provider Business Mailing Address
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Address Line | 1170 S SEMORAN BLVD SUITE D
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City | ORLANDO
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State | FL
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Zip | 32807-1458
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Country | US
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Telephone | 407-282-4142
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Fax | 407-282-7475
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIBEL AVILES
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Credential | MD
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Telephone | 407-282-4142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0066465
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License Number State | FL
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