| NPI | 1609512656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ORLAND MATA CEO 863-840-0639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2024-07-15 |