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General NPI Number Information
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NPI Number | 1558366195
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Entity Type | Individual
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Provider Name | MARILIZ BORBON BUMGARNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 5150 CURRY FORD RD
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City | ORLANDO
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State | FL
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Zip | 32812-8744
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Country | US
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Telephone | 407-286-3653
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Fax | 407-286-4739
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Provider Business Mailing Address
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Address Line | 5150 CURRY FORD RD
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City | ORLANDO
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State | FL
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Zip | 32812-8744
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Country | US
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Telephone | 239-600-9389
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Fax | 407-286-4739
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 91688
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME-91688
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME91688
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License Number State | FL
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