Provider Demographics
NPI:1336960012
Name:CELEBRATION OBSTETRICS AND GYNECOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:CELEBRATION OBSTETRICS AND GYNECOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-300-2410
Mailing Address - Street 1:PO BOX 818018
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44181-8018
Mailing Address - Country:US
Mailing Address - Phone:561-300-2410
Mailing Address - Fax:
Practice Address - Street 1:410 CELEBRATION PL STE 208
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5434
Practice Address - Country:US
Practice Address - Phone:407-566-2229
Practice Address - Fax:407-566-2499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FWC PERINATAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty