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General NPI Number Information
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NPI Number | 1376799593
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HEALTHCARE OF CENTRAL FLORIDA, LLC
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 2105 HARTWOOD MARSH RD SUITE 9
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City | CLERMONT
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State | FL
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Zip | 34711-5389
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Country | US
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Telephone | 352-404-9200
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Fax | 352-404-9232
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Provider Business Mailing Address
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Address Line | 2105 HARTWOOD MARSH RD SUITE 9
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City | CLERMONT
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State | FL
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Zip | 34711-5389
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Country | US
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Telephone | 352-404-9200
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Fax | 352-404-9232
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MARIA ELENA DUMALAOG-WATSON
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Credential | MD
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Telephone | 407-716-5521
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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 | ME77853
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License Number State | FL
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