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General NPI Number Information
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NPI Number | 1699348375
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Entity Type | Organization
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Legal Business Name | OLGPA ENTERPRISE LLC
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 6718 LAKE NONA BLVD STE 240
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City | ORLANDO
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State | FL
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Zip | 32827-7985
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Country | US
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Telephone | 863-758-2273
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Fax | 305-400-4176
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Provider Business Mailing Address
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Address Line | PO BOX 950572
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City | LAKE MARY
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State | FL
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Zip | 32795-0572
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Country | US
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Telephone | 863-758-2273
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Fax | 305-400-4176
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Authorized Official
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Title or Position | MANAGER
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Name | MS. OLGA DIAZ
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Credential |
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Telephone | 202-361-9290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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