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General NPI Number Information
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NPI Number | 1629671383
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Entity Type | Organization
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Legal Business Name | FLORIDA EEG LLC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 117 N KIRKMAN RD STE 3
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City | ORLANDO
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State | FL
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Zip | 32811-1403
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Country | US
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Telephone | 407-408-2445
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Fax |
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Provider Business Mailing Address
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Address Line | 117 N KIRKMAN RD STE 3
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City | ORLANDO
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State | FL
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Zip | 32811-1403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JESSICA BALLESTERO
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Credential |
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Telephone | 407-408-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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