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General NPI Number Information
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NPI Number | 1497806715
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Entity Type | Organization
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Legal Business Name | REGAL FAMILY CARE, INC.
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 1120 CITRUS TOWER BLVD SUITE 300
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City | CLERMONT
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State | FL
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Zip | 34711-1909
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Country | US
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Telephone | 352-243-0206
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Fax | 352-243-1822
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Provider Business Mailing Address
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Address Line | PO BOX 2379
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City | MINNEOLA
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State | FL
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Zip | 34755-2379
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Country | US
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Telephone | 352-243-0206
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Fax | 352-243-1822
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Authorized Official
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Title or Position | PRESIDENT
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Name | NELLY A OTERO
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Credential | M.D
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Telephone | 352-243-0206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME52940
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License Number State | FL
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