=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356601702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KM FAMILY PHYSICIAN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2012
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W. KALEY ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-872-8490
-----------------------------------------------------
Fax | 407-872-2454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 W KALEY AVE. SUITE 300 B
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-323-7618
-----------------------------------------------------
Fax | 407-323-7618
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KARELINA MUGUERCIA
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 407-872-8491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME100037
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------