=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679084164
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | H&H CARE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2017
-----------------------------------------------------
Last Update Date | 10/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 MENDHAM BLVD STE 104
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32825-3245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-645-2577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7802 KINGSPOINTE PKWY STE 208A
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-8579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-900-9284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. JUAN CARLOS CANTU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-900-9284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------