=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902753130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA CARE MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2026
-----------------------------------------------------
Last Update Date | 03/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4691 OLD CANOE CREEK RD
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34769-1550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-842-8283
-----------------------------------------------------
Fax | 407-603-8285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7200 CURRY FORD RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32822-5806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-842-8283
-----------------------------------------------------
Fax | 407-603-8285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PEDRO ENRIQUE LASTRES HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-842-8283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------