| NPI | 1730777053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAUL VARGAS RIVERA Md 407-315-3637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-01-03 |
| Last Update Date | 2023-09-13 |