Provider Demographics
NPI:1255856589
Name:ORLANDO CENTER FOR ADVANCED PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:ORLANDO CENTER FOR ADVANCED PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-333-2525
Mailing Address - Street 1:4106 W LAKE MARY BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3344
Mailing Address - Country:US
Mailing Address - Phone:407-333-2525
Mailing Address - Fax:407-333-9583
Practice Address - Street 1:4106 W LAKE MARY BLVD STE 212
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3344
Practice Address - Country:US
Practice Address - Phone:407-333-2525
Practice Address - Fax:407-333-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty