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General NPI Number Information
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NPI Number | 1659380459
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Entity Type | Organization
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Legal Business Name | NEW INTERLACHEN PEDIATRICS, P.A.
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 846 LAKE HOWELL RD
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City | MAITLAND
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State | FL
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Zip | 32751-5222
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Country | US
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Telephone | 407-767-2477
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Fax | 407-834-9822
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Provider Business Mailing Address
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Address Line | 846 LAKE HOWELL RD
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City | MAITLAND
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State | FL
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Zip | 32751-5222
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Country | US
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Telephone | 407-767-2477
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Fax | 407-834-9822
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. LUIS SALAZAR
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Credential |
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Telephone | 407-767-2477
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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 |
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License Number State |
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