=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477990869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE DOLPHIN HEALTH CARE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2013
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4428 MEADOWOOD ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32812-7925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-553-0954
-----------------------------------------------------
Fax | 786-502-2503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4428 MEADOWOOD ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32812-7925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-553-0954
-----------------------------------------------------
Fax | 305-675-8240
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADULT PSYCHIATRY-NP /OWNER
-----------------------------------------------------
Name | MRS. ASUNCION MARINA MUNOZ
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 786-553-0954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 8287
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 9292609
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------