Provider Demographics
NPI:1699893701
Name:CENTRAL FLORIDA PRIMARY CARE PA
Entity type:Organization
Organization Name:CENTRAL FLORIDA PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-380-1951
Mailing Address - Street 1:172 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3293
Mailing Address - Country:US
Mailing Address - Phone:407-380-1951
Mailing Address - Fax:407-380-1343
Practice Address - Street 1:172 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3293
Practice Address - Country:US
Practice Address - Phone:407-380-1951
Practice Address - Fax:407-380-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty