| NPI | 1053077123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMARILYS CORTES-MORA Business Administrator 407-207-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2025-09-11 |