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General NPI Number Information
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NPI Number | 1407655822
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Entity Type | Organization
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Legal Business Name | ELITE OB-GYN SURGERY LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 801 N ORANGE AVE STE 710
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City | ORLANDO
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State | FL
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Zip | 32801-5202
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Country | US
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Telephone | 407-529-7752
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Fax | 407-459-7542
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Provider Business Mailing Address
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Address Line | 801 N ORANGE AVE STE 710
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City | ORLANDO
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State | FL
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Zip | 32801-5202
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Country | US
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Telephone | 407-529-7752
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Fax | 407-459-7542
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOHNNY RIVERA JR.
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Credential |
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Telephone | 407-529-7752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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