Provider Demographics
NPI:1316500796
Name:BRIGHT HEALTH CLINIC CORP
Entity type:Organization
Organization Name:BRIGHT HEALTH CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEYDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-960-1413
Mailing Address - Street 1:3592 ALOMA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4012
Mailing Address - Country:US
Mailing Address - Phone:407-960-1413
Mailing Address - Fax:407-960-1553
Practice Address - Street 1:3592 ALOMA AVE STE 5
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4012
Practice Address - Country:US
Practice Address - Phone:407-960-1413
Practice Address - Fax:407-960-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty