=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952770752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINGDOM COME ENTERPRISES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2015
-----------------------------------------------------
Last Update Date | 09/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2509 OAK RUN BLVD
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34744-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-443-7570
-----------------------------------------------------
Fax | 407-681-4603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2509 OAK RUN BLVD
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34744-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-443-7570
-----------------------------------------------------
Fax | 407-681-4603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ISMAEL A BELOSO
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 321-443-7570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | OS10148
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------