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General NPI Number Information
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NPI Number | 1669681904
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Entity Type | Organization
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Legal Business Name | ORLAND MED THERAP GROUP INC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 3760 N JOHN YOUNG PKWY SUITE 103
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City | ORLANDO
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State | FL
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Zip | 32804-3220
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Country | US
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Telephone | 407-293-7600
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Fax | 407-293-7609
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Provider Business Mailing Address
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Address Line | 3760 N JOHN YOUNG PKWY SUITE 103
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City | ORLANDO
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State | FL
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Zip | 32804-3220
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Country | US
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Telephone | 407-293-7600
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Fax | 407-293-7609
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANDRES BLANCO
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Credential | M.A.
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Telephone | 407-293-7600
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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 | HCC5917
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License Number State | FL
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