Provider Demographics
NPI:1225089436
Name:ELLO, FLORENCIO VALLEJOS (MD)
Entity Type:Individual
Prefix:
First Name:FLORENCIO
Middle Name:VALLEJOS
Last Name:ELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3293
Mailing Address - Country:US
Mailing Address - Phone:407-380-1951
Mailing Address - Fax:407-380-1343
Practice Address - Street 1:172 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3293
Practice Address - Country:US
Practice Address - Phone:407-380-1951
Practice Address - Fax:407-380-1343
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF53908Medicare UPIN
FL16913VMedicare ID - Type Unspecified