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General NPI Number Information
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NPI Number | 1578094629
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Entity Type | Organization
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Legal Business Name | CONGENITAL HEART CARE CENTER OF FLORIDA
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 425 S HUNT CLUB BLVD STE 1001
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City | APOPKA
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State | FL
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Zip | 32703-4947
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Country | US
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Telephone | 407-862-1010
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Fax | 407-862-1016
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Provider Business Mailing Address
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Address Line | 360 N LAKE SYBELIA DR
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City | MAITLAND
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State | FL
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Zip | 32751-4720
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Country | US
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Telephone | 407-862-1010
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Fax | 407-862-1016
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AURELIO REYES II
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Credential | MD
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Telephone | 407-862-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | ME86455
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License Number State | FL
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