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NPI Code Detail

MEDICARE: IGLESIA BAUTISTA CENTRAL DE KISSIMMEE, INC.

MEDICARE: IGLESIA BAUTISTA CENTRAL DE KISSIMMEE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1518312909
Entity Type Code : Organization
Provider Name (Legal Business Name) : IGLESIA BAUTISTA CENTRAL DE KISSIMMEE, INC.
Provider Business Mailing Address
First Line : 1420 SIMPSON RD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-4600
Country : US
Telephone Number : 407-348-2060
Fax Number : 407-348-2063
Provider Business Practice Location Address
First Line : 1420 SIMPSON RD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-4600
Country : US
Telephone Number : 407-348-2060
Fax Number : 407-348-2063
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : BENJAMIN O GONZALEZ
Credential :
Telephone Number : 407-348-2060
Provider Enumeration Date : 05/04/2016
Last Update Date : 07/20/2016

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Directions to “IGLESIA BAUTISTA CENTRAL DE KISSIMMEE, INC. ” Practice Location

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