Provider Demographics
NPI:1982574752
Name:PENTUS HEALTH PRIMARY CARE WB LLC
Entity type:Organization
Organization Name:PENTUS HEALTH PRIMARY CARE WB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-756-3474
Mailing Address - Street 1:2273 LEE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7217
Mailing Address - Country:US
Mailing Address - Phone:844-973-6887
Mailing Address - Fax:
Practice Address - Street 1:1116 PROFESSIONAL DR STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3378
Practice Address - Country:US
Practice Address - Phone:844-973-6887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-07
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty