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General NPI Number Information
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NPI Number | 1538198783
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Entity Type | Organization
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Legal Business Name | CFA KIDNEY & HYPERTENSION CENTER LLC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 587 E STATE ROAD 434 SUITE 1011
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City | LONGWOOD
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State | FL
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Zip | 32750-5284
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Country | US
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Telephone | 321-214-4133
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Fax | 321-214-4216
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Provider Business Mailing Address
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Address Line | P O BOX 915467
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City | LONGWOOD
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State | FL
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Zip | 32791-5467
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Country | US
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Telephone | 321-214-4133
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Fax | 321-214-4216
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OLUFUNMILOLA OLUWAKEMI DARAMOLA-OGUNWUYI
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Credential | MD
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Telephone | 321-214-4133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | L06000028969
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License Number State | FL
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