Basic Information
| Provider Information | |||||||||
| NPI: | 1962714790 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL FLORIDA PRIMARY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7901 KINGSPOINTE PKWY | ||||||||
| Address2: | STE 1 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328196520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073458894 | ||||||||
| FaxNumber: | 4073458895 | ||||||||
| Practice Location | |||||||||
| Address1: | 1555 SAXON BLVD | ||||||||
| Address2: | STE 301 | ||||||||
| City: | DELTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327255861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3865741423 | ||||||||
| FaxNumber: | 3868609239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2010 | ||||||||
| LastUpdateDate: | 10/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | VELASCO | ||||||||
| AuthorizedOfficialFirstName: | ANDRES | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3865741423 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME96936 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.