Provider Demographics
NPI:1487888764
Name:CENTRAL FLORIDA EXPRESS CARE
Entity type:Organization
Organization Name:CENTRAL FLORIDA EXPRESS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICA DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:352-693-2333
Mailing Address - Street 1:17809 SE 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8912
Mailing Address - Country:US
Mailing Address - Phone:352-693-2333
Mailing Address - Fax:352-693-2334
Practice Address - Street 1:17809 SE 109TH AVE
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8912
Practice Address - Country:US
Practice Address - Phone:352-693-2333
Practice Address - Fax:352-693-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99270146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty