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General NPI Number Information
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NPI Number | 1487888764
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA EXPRESS CARE
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 17809 SE 109TH AVE
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8912
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Country | US
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Telephone | 352-693-2333
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Fax | 352-693-2334
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Provider Business Mailing Address
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Address Line | 17809 SE 109TH AVE
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8912
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Country | US
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Telephone | 352-693-2333
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Fax | 352-693-2334
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Authorized Official
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Title or Position | MEDICA DIRECTOR
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Name | DR. RAVI P GUPTA
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Credential | M. D.
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Telephone | 352-693-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | ME99270
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License Number State | FL
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