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General NPI Number Information
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NPI Number | 1659820546
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Entity Type | Organization
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Legal Business Name | COMMONHEALTH SERVICES CORP.
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 733 N 3RD ST
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City | LEESBURG
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State | FL
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Zip | 34748-4441
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Country | US
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Telephone | 352-435-7214
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Fax | 352-435-7553
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Provider Business Mailing Address
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Address Line | 960 MAPLE FOREST DR
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City | ORLANDO
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State | FL
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Zip | 32825-6450
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Country | US
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Telephone | 407-275-1373
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CARLOS MANUEL DE LA CRUZ
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Credential | R.PH.
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Telephone | 407-275-1373
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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 | ME69780
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License Number State | FL
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