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General NPI Number Information
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NPI Number | 1891438321
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Entity Type | Organization
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Legal Business Name | DR PALES HEALTHCARE PROVIDER
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 8390 CHAMPIONS GATE BLVD SUITE 108
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896
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Country | US
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Telephone | 863-521-4497
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Fax |
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Provider Business Mailing Address
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Address Line | 8390 CHAMPIONS GATE BLVD SUITE 108
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896
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Country | US
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Telephone | 407-683-9205
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | PAOLA RAMIREZ
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Credential | MA
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Telephone | 863-521-4497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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