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General NPI Number Information
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NPI Number | 1700871795
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Entity Type | Organization
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Legal Business Name | WATERFORD LAKES WOMEN'S HEALTH CENTER
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11399 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32825-5023
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Country | US
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Telephone | 407-207-6768
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Fax | 407-249-5025
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Provider Business Mailing Address
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Address Line | 11399 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32825-5023
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Country | US
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Telephone | 407-207-6768
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Fax | 407-249-5025
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Authorized Official
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Title or Position | OWNER
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Name | DR. FERNANDO LOPEZ
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Credential | M.D.
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Telephone | 407-207-6768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | FL
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Taxonomy #2
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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 | FL
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