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General NPI Number Information
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NPI Number | 1821973587
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Entity Type | Organization
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Legal Business Name | HUMANITARY MEDICAL CENTER KISSIMMEE, INC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 1507 N JOHN YOUNG PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34741-3214
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Country | US
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Telephone | 407-288-8850
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Fax | 407-214-1333
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Provider Business Mailing Address
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Address Line | 3109 W DR MARTIN LUTHER KING JR BLVD STE 121
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City | TAMPA
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State | FL
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Zip | 33607-6240
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Country | US
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Telephone | 813-708-1313
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Fax | 813-945-3771
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIECER GONZALEZ
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Credential |
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Telephone | 813-468-1866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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