Provider Demographics
NPI:1376661710
Name:DELTONA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:DELTONA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISANTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:386-668-9841
Mailing Address - Street 1:747 FAWN RIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8268
Mailing Address - Country:US
Mailing Address - Phone:386-668-9800
Mailing Address - Fax:386-668-3777
Practice Address - Street 1:747 FAWN RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8268
Practice Address - Country:US
Practice Address - Phone:386-668-9800
Practice Address - Fax:386-668-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9358Medicare ID - Type Unspecified