Provider Demographics
NPI:1063787778
Name:OQUENDO, ORVILLE JOSUE (X-RAY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:ORVILLE
Middle Name:JOSUE
Last Name:OQUENDO
Suffix:
Gender:M
Credentials:X-RAY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 ARROWSMITH AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1151 BLACKWOOD AVE STE 170
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4523
Practice Address - Country:US
Practice Address - Phone:407-347-8339
Practice Address - Fax:407-347-8394
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBMO619702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology