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General NPI Number Information
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NPI Number | 1831362805
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Entity Type | Organization
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Legal Business Name | LAKE WALE PEDIATRIC INTERNAL MEDICINE P.A.
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 425 S 11TH ST
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City | LAKE WALES
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State | FL
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Zip | 33853-4239
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Country | US
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Telephone | 863-676-8935
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Fax | 863-679-2691
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Provider Business Mailing Address
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Address Line | 425 S 11TH ST
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City | LAKE WALES
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State | FL
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Zip | 33853-4239
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Country | US
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Telephone | 863-676-8935
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Fax | 863-679-2691
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. OSCAR AMADOR OROPEZA
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Credential | M.D.
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Telephone | 863-676-8935
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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 | ME87271-ME90317
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License Number State | FL
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