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General NPI Number Information
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NPI Number | 1396605507
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Entity Type | Organization
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Legal Business Name | LAKE NONA SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/12/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 6424 ALEXANDRA LOUISE DR STE 400
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City | ORLANDO
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State | FL
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Zip | 32827-5810
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Country | US
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Telephone | 407-610-6648
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Fax | 855-719-2579
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Provider Business Mailing Address
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Address Line | 6424 ALEXANDRA LOUISE DR STE 400
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City | ORLANDO
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State | FL
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Zip | 32827-5810
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Country | US
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Telephone | 407-610-6648
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Fax | 855-719-2579
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Authorized Official
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Title or Position | MGR
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Name | MR. REY ESTEVAN
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Credential |
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Telephone | 352-622-4251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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