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General NPI Number Information
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NPI Number | 1316159023
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Entity Type | Organization
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Legal Business Name | THE FAMILY DOCTORS OF BUENA VENTURA PA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 14050 TOWN LOOP BLVD SUITE 201
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City | ORLANDO
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State | FL
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Zip | 32837-6190
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Country | US
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Telephone | 407-348-0399
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Fax | 407-348-8350
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Provider Business Mailing Address
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Address Line | 14050 TOWN LOOP BLVD SUITE 201
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City | ORLANDO
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State | FL
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Zip | 32837-6190
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Country | US
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Telephone | 407-348-0399
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Fax | 407-348-8350
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIN BAUTISTA
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Credential | M.D
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Telephone | 407-348-0399
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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 | ME62124
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License Number State | FL
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