| NPI | 1558632687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS M LOPEZ Officer 352-861-5765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: FL me) |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2012-01-20 |