Provider Demographics
NPI:1326217696
Name:ENID BERRIOS LLC
Entity Type:Organization
Organization Name:ENID BERRIOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ENID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERRIOS- MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-695-2872
Mailing Address - Street 1:116 SEVILLE CHASE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-3920
Mailing Address - Country:US
Mailing Address - Phone:407-695-2872
Mailing Address - Fax:407-695-2872
Practice Address - Street 1:809 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2008
Practice Address - Country:US
Practice Address - Phone:407-682-7275
Practice Address - Fax:407-682-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97683208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty