Provider Demographics
NPI:1194712935
Name:CANTILLI, LORETTA (MD)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:
Last Name:CANTILLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDRINA
Other - Middle Name:LORETTA
Other - Last Name:CANTILLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:801 WEST OAK STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-846-3455
Mailing Address - Fax:407-846-3670
Practice Address - Street 1:801 WEST OAK STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-846-3455
Practice Address - Fax:407-846-3670
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE94152Medicare UPIN