Provider Demographics
NPI:1326095951
Name:MED PHENIX INC
Entity Type:Organization
Organization Name:MED PHENIX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GANUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-375-7578
Mailing Address - Street 1:2020 SEVEN SPRINGS BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-375-7578
Mailing Address - Fax:727-375-7568
Practice Address - Street 1:2020 SEVEN SPRINGS BLVD
Practice Address - Street 2:STE B
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-375-7578
Practice Address - Fax:727-375-7568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29235204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51105XMedicare ID - Type Unspecified
D55969Medicare UPIN
FLK9645Medicare ID - Type Unspecified