| NPI | 1477898575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNYS C VARGAS CEO 407-300-5813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL 26471961) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2022-07-21 |